Journal of hepato-biliary-pancreatic sciences
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J Hepatobiliary Pancreat Sci · Nov 2011
Review Meta AnalysisPancreaticojejunostomy versus pancreaticogastrostomy.
In the majority of reports morbidity after pancreaticoduodenectomy remains high and leakage from the pancreatic stump still accounts for the majority of surgical complications. Many technical modifications of the pancreaticoenteric anastomosis to decrease the pancreatic leakage rate have been suggested. ⋯ Pancreaticojejunostomy appears to be the most widely performed reconstruction, but pancreaticogastrostomy is a reasonable alternative. However, in the analysis of the clinical results it is important to know which specific pancreaticoenteric anastomosis is considered; for example, end-to-end, dunking, invagination of the pancreatic stump, or duct-to-mucosa. It is hoped that collaborative trials will provide high-level data to allow tailoring of the operative technique, depending on the risk factors for pancreatic leakage in any particular patient.
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J Hepatobiliary Pancreat Sci · Nov 2011
ReviewUse of pancreatic duct stents after pancreaticoduodenectomy.
After pancreaticoduodenectomy, the pancreatic anastomosis carries the highest risk of leak and cause of morbidity and mortality. In this review article, three randomized controlled clinical trials and a fourth prospective trial focused on pancreaticoduodenectomy that contribute to level-one evidence are examined. The Johns Hopkins group demonstrated that internal pancreatic duct stenting did not decrease the frequency or severity of postoperative pancreatic fistulas. ⋯ The University of Athens group demonstrated that internal stenting of the pancreaticojejunostomy anastomosis did not reduce the incidence of pancreatic fistula and related complications. Finally, the French Surgery Research Group demonstrated that the use of an external stent through the pancreatic anastomosis reduced the pancreatic fistula rate. In summary, two studies do not demonstrate an advantage to the use of internal pancreatic duct stents and two studies demonstrate a possible advantage to the use of external pancreatic duct stents, especially in highest risk patients with soft glands and small pancreatic ducts.
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J Hepatobiliary Pancreat Sci · Jul 2011
Comparative StudySinisan, a traditional Chinese medicine, attenuates experimental chronic pancreatitis induced by trinitrobenzene sulfonic acid in rats.
Sinisan, a traditional Chinese medicine, is effective for the treatment of gastrointestinal disorders. In this study, we investigated the potential protective role of Sinisan against chronic pancreatitis (CP) in rats. ⋯ Sinisan could be an effective treatment modality for CP via its anti-inflammatory, anti-fibrotic and analgesic properties. It may be a promising drug candidate for the treatment of patients with CP.
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J Hepatobiliary Pancreat Sci · Jul 2011
Multicenter Study Comparative StudyPredictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
It is important to predict the development of clinically relevant pancreatic fistula (grade B/C) in the early period after pancreaticoduodenectomy (PD). This study has been carried out as a project study of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHPBS) to evaluate the predictive factors associated with clinically relevant pancreatic fistula (grade B/C). ⋯ The four predictive risk factors identified here can provide useful information useful for tailoring postoperative management of clinically relevant pancreatic fistula (grade B/C).
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J Hepatobiliary Pancreat Sci · May 2011
Comparative StudyThe effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function.
In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. ⋯ In our study, the administration of MB at 1-1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT.