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Asian Journal of Surgery Feb 2024Robotic pancreaticoduodenectomy in ampullary cancer has never been studied. This study aimed to clarify the feasibility and justification of robotic...
BACKGROUND/OBJECTIVE
Robotic pancreaticoduodenectomy in ampullary cancer has never been studied. This study aimed to clarify the feasibility and justification of robotic pancreaticoduodenectomy in ampullary cancer in terms of surgical risks, and oncologic and survival outcomes.
METHODS
A propensity score-matching comparison of robotic and open pancreaticoduodenectomy based on seven factors commonly used to predict the survival outcomes in ampullary cancer patients.
RESULTS
A total of 147 patients were enrolled, of which 101 and 46 underwent robotic and open pancreaticoduodenectomies, respectively. After propensity score-matching with a 2:1 ratio, 88 and 44 patients in the robotic and open pancreaticoduodenectomy groups were included. The operation time was of no significant difference after matching. The median intraoperative blood loss was much less in those who underwent robotic pancreaticoduodenectomy, both before (median, 120 vs. 320 c.c. P < 0.001) and after (100 vs. 335 mL P < 0.001) score-matching. There were no significant differences in terms of surgical risks, including surgical mortality, surgical morbidity, Clavien-Dindo severity classification, postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, chyle leak, bile leak, and wound infection, both before or after score-matching. The survival outcomes were also similar between the two groups, regardless of matching.
CONCLUSIONS
Robotic pancreaticoduodenectomy for ampullary cancer is not only technically feasible and safe without increasing surgical risks, but also oncologically justifiable without compromising surgical radicality and survival outcomes.
Topics: Humans; Pancreaticoduodenectomy; Ampulla of Vater; Robotic Surgical Procedures; Propensity Score; Common Bile Duct Neoplasms; Postoperative Complications; Treatment Outcome; Retrospective Studies; Pancreatic Neoplasms; Laparoscopy
PubMed: 37925285
DOI: 10.1016/j.asjsur.2023.10.076 -
Medicine Oct 2023The Hem-o-lok clip, made from a nonabsorbable polymer, and its predecessor the metal ligation clip have been used widely for laparoscopic or robot-assisted surgery to...
RATIONALE
The Hem-o-lok clip, made from a nonabsorbable polymer, and its predecessor the metal ligation clip have been used widely for laparoscopic or robot-assisted surgery to ligate the cystic duct after a cholecystectomy, to ligate the appendix after an appendectomy, or control hemorrhage or on occasion to occlude a fistula or enterotomy. Displacement of these ligation clips to distant sites is an extremely rare complication in clinical practice.
PATIENT CONCERNS
The patient is a 67-year old female who sought medical attention for 3 days due to worsening intermittent upper abdominal pain and poor appetite. Gastroscopy showed both an ulcer and the presence of a foreign object embedded in the anterior wall of the duodenal bulb, consistent with what looked like a polymer-based ligation clip. After removal of the foreign body, which turned out to be a remnant of the polymer clip, no further pus was seen, but fresh granulomatous tissues were seen at the base.
DIAGNOSES
a polymer-based clip-induced duodenal bulb erosion with a local contained enterically draining abscess.
INTERVENTIONS
The patient recovered after removing foreign bodies under gastroscopy and receiving anti infection treatment.
OUTCOMES
The patient recovered after removing foreign bodies under gastroscopy and receiving anti infection treatment.
LESSONS
In laparoscopic cholecystectomy, attention should be paid to the correct surgical techniques, possibly by decreasing the number of such clips used or considering use of absorbable clips, ligature wires, ligation with absorbable suture material, or ultrasonic resection, all of which can be used for clipless cholecystectomy.
Topics: Female; Humans; Aged; Polymers; Abscess; Duodenum; Laparoscopy; Cholecystectomy, Laparoscopic; Foreign Bodies; Surgical Instruments
PubMed: 37904458
DOI: 10.1097/MD.0000000000035783 -
ACG Case Reports Journal Oct 2023Distal stent migration leading to duodenal perforation is an uncommon complication of endoscopic biliary plastic stent placement. We present a case in which a patient...
Distal stent migration leading to duodenal perforation is an uncommon complication of endoscopic biliary plastic stent placement. We present a case in which a patient with a migrated biliary plastic stent that perforated through the duodenum was managed expectantly until a duodenocolic fistula formed prior to endoscopic removal.
PubMed: 37899955
DOI: 10.14309/crj.0000000000001192 -
Surgery Open Science Dec 2023Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump...
Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump fistulas by placing a modified sump drainage through trocar puncture into the DSF-related abscess (DSF-abscess) cavity. We retrospectively analyzed 974 consecutive patients who underwent gastrectomy for gastric cancer between 2011 and 2021. Of these patients, 34 who developed postoperative duodenal stump fistulas postoperatively were enrolled into our study, and their clinical data were retrospectively assessed. From January 2011 to December 2017, 15 patients received conventional treatments (percutaneous catheter drainage, PCD group) known as the traditional percutaneous method, and 19 patients from January 2018 to December 2021 received new treatments (Troca's SD group) consisting of conventional therapies and placement of a modified sump drainage through trocar puncture into DSF-abscess cavity. The demographics, clinical characteristics and treatment outcomes were compared between two groups. Compared with the PCD group, the rates of postoperative complications, duodenostomy creation, subsequent surgery, fistula healing rates of the DSF, and length of postoperative hospital stay were significantly decreased in the Troca SD group. However, there was no significant difference in the abscess recurrence rate and mortality rates. Trocar puncture with a modified sump drainage is an safe, effective, and technically feasible treatment for duodenal stump fistula after radical gastrectomy for gastric cancer. This novel technique should be further investigated using large-scale RCT research.
PubMed: 37876666
DOI: 10.1016/j.sopen.2023.09.015 -
Federal Practitioner : For the Health... Jul 2023A duodenocaval fistula is seen when a connection exists between the duodenum and the inferior vena cava. It is a rare entity that presents a diagnostic challenge due to...
BACKGROUND
A duodenocaval fistula is seen when a connection exists between the duodenum and the inferior vena cava. It is a rare entity that presents a diagnostic challenge due to its nonspecific presenting symptoms and often is found only during a laparotomy or autopsy.
CASE PRESENTATION
A 37-year-old man initially presented to the hospital for melena but went into cardiac arrest before undergoing an esophagogastroduodenoscopy. Unfortunately, a duodenocaval fistula was only found during the autopsy.
CONCLUSIONS
Duodenocaval fistula is a diagnostic challenge as it may present with nonspecific findings concerning for other etiologies. We want to highlight that although rare, duodenocaval fistula should be considered for patients who present with gastrointestinal bleeding and hypoxic respiratory failure.
PubMed: 37868713
DOI: 10.12788/fp.0391 -
Radiology Case Reports Dec 2023Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with...
Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with the duodenum or stomach. The diagnosis is challenging due to its atypical clinical manifestations. There have been a few reported cases of Bouveret syndrome presenting with gastrointestinal bleeding. Treatment options include both endoscopic and surgical approaches. We present the case of a 92-year-old woman admitted to the emergency department for upper gastrointestinal bleeding. Gastroscopy revealed gastric stasis upstream of a calculus inducing an obstruction of the bulb. The computed tomography (CT) scan showed a cholecystoduodenal fistula with a calculus lodged in the bulb. The patient underwent a gastrostomy with extraction of the calculus. Postoperative course was uneventful and the patient was discharged home. In the majority of cases, Bouveret's syndrome is revealed by an upper gastrointestinal obstruction, but other signs, such as gastrointestinal bleeding, can be seen. The diagnosis is confirmed by an imaging method that highlights Rigler's triad. The management can be either endoscopic or surgical depending on the patient's general condition. The diagnosis is often difficult due to the lack of specificity in the symptoms. Presently, there exists no consensus concerning the appropriate approach for its management.
PubMed: 37868004
DOI: 10.1016/j.radcr.2023.09.052 -
Journal of Pediatric Surgery Jan 2024Recent series of newborn Oesophageal Atresia (OA) repair continue to report widespread use of chest drains, gastrostomy, routine contrast studies and parenteral...
PURPOSE
Recent series of newborn Oesophageal Atresia (OA) repair continue to report widespread use of chest drains, gastrostomy, routine contrast studies and parenteral nutrition (PN) despite evidence suggesting these are superfluous. We report outcomes using a minimally interventional approach to post-operative recovery.
METHODS
Ethically approved (15/WA/0153), single-centre, retrospective case-note review of consecutive infants with OA 2000-2022. Infants with OA and distal trache-oesophageal fistula undergoing primary oesophageal anastomosis at initial surgery were included (including those with comorbidities such as duodenal atresia, anorectal malformation and cardiac lesions). Our practice includes routine use of a trans-anastomotic tube (TAT), no routine chest drain nor gastrostomy, early enteral and oral feeding, no routine PN and no routine contrast study. Data are median (IQR).
RESULTS
Of total 186 cases of OA treated during the time period, 157 met the inclusion criteria of which 2 were excluded as casenotes unavailable. TAT was used in 150 infants. A chest drain was required in 13 (8%) and two infants had a neonatal gastrostomy. Enteral feeds were started on postoperative day 2 (2-3), full enteral feeds established by day 4 (4-6) and oral feeds started on day 5 (4-8). PN was required in 15%. Median postoperative length of stay was 10 days (8-17). Progress was quicker in term infants than preterm. One infant died of cardiac disease prior to neonatal discharge. Two planned post-operative contrast studies were performed (surgeon preference) and a further 7 due to clinical suspicion of anastomotic leak. Contrast study was therefore avoided in 94%. There were 2 anastomotic leaks; both presented clinically at day 4 and day 8 after oral feeds had been started.
CONCLUSION
Our minimally interventional approach is safe. It facilitates prompt recovery with lower resource use, reduced demand on nursing staff, reduced radiation burden, and early discharge home compared to published series without adversely affecting outcomes.
LEVEL OF EVIDENCE
Level 4.
Topics: Infant, Newborn; Infant; Humans; Esophageal Atresia; Enteral Nutrition; Retrospective Studies; Anastomotic Leak; Gastrostomy
PubMed: 37867045
DOI: 10.1016/j.jpedsurg.2023.09.026 -
Journal of Surgical Case Reports Oct 2023Bouveret syndrome is a rare cause of gastric outlet obstruction, a consequence of a large impacted gallstone leading to the formation of a bilioenteric fistula. We...
Bouveret syndrome is a rare cause of gastric outlet obstruction, a consequence of a large impacted gallstone leading to the formation of a bilioenteric fistula. We present a case of a 79-year-old female who presented with a history of persistent nausea and vomiting. Computed tomography of the abdomen revealed a large gallstone impacted in the second part of the duodenum, complicated by a cholecystoduodenal fistula, leading to gastric outlet obstruction. After nasogastric decompression, the patient underwent an upper gastrointestinal endoscopy and attempted stone retrieval which was unsuccessful. Consequently, she underwent laparotomy, gastrotomy, and extraction of the stone. This case highlights the pitfalls of managing Bouveret syndrome via an endoscopic or an open surgical approach.
PubMed: 37854526
DOI: 10.1093/jscr/rjad570 -
Annals of Medicine and Surgery (2012) Oct 2023Gallstone ileus is a rare and potentially life-threatening condition characterized by the obstruction of the small intestine due to a gallstone. It occurs as a...
INTRODUCTION AND IMPORTANCE
Gallstone ileus is a rare and potentially life-threatening condition characterized by the obstruction of the small intestine due to a gallstone. It occurs as a complication of gallstone disease, where a large gallstone erodes through the gallbladder into the gastrointestinal tract, creating a fistula.
CASE PRESENTATION
A type 2 diabetic woman in her 50s presented to the emergency department complaining of abdominal pain and vomiting. She has not emptied her bowels since 3 days ago. A clinical examination showed tenderness in the abdomen associated with fecal vomiting. A computed tomography (CT) scan was performed and showed a dilated gallbladder with gas. A giant gallstone in a small intestinal loop was observed. The diagnosis was a small intestinal obstruction due to a giant gallstone and a duodenal-biliary fistula.
CLINICAL DISCUSSION
Gallstone ileus is an occasional complication of cholelithiasis, occurring in less than 0.5% of patients. Gallstone ileus frequently occurs in the terminal ileum and the ileocecal valve. Regarding the clinical presentation, abdominal pain is the most common symptom, followed by vomiting and constipation. CT scan is the gold standard utilized to diagnose gallstone ileus. Surgical intervention is the mainstay treatment for giant gallstone ileus, with enterolithotomy being the most commonly performed procedure.
CONCLUSION
Gallstone ileus is an uncommon but potentially life-threatening condition that can emerge in elderly patients with a history of cholelithiasis. It is crucial for clinicians to maintain a high index of suspicion when encountering older patients with risk factors for cholelithiasis and intestinal obstruction.
PubMed: 37811086
DOI: 10.1097/MS9.0000000000001211 -
Cureus Sep 2023Gallstones causing bowel obstruction, known as gallstone ileus, are rare and account for less than 0.5% of small bowel obstruction cases. Additionally, it is a rare...
Gallstones causing bowel obstruction, known as gallstone ileus, are rare and account for less than 0.5% of small bowel obstruction cases. Additionally, it is a rare complication affecting only 0.3% of patients who have gallstones. Fistula formation between the biliary system, most commonly between the gallbladder and duodenum because of their proximity, facilitates the migration of gallstones into the enteric system with subsequent impaction in the small intestine, usually in the distal ileum close to the ileocecal valve, promoting the development of mechanical small bowel obstruction. Computerized tomography of the abdomen and pelvis is a confirmatory and widely used imaging study when there are two signs of Rigler's triad, which includes pneumobilia, evidence of small bowel obstruction and the presence of radiopaque stones. We report a case of a 75-year-old Caucasian man who presented with abdominal distention with signs of severe dehydration secondary to intractable nausea and vomiting complicated with severe acute kidney injury and was found to have a 4.7-centimeter gallstone-induced small intestinal obstruction.
PubMed: 37809230
DOI: 10.7759/cureus.44707