Archives of surgery (Chicago, Ill. : 1960)
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Postoperative pancreatic fistula (POPF) is one of the most severe surgical complications of pancreatoduodenectomy (PD) with pancreaticojejunostomy (PJ) reconstruction. Recently, POPF has been classified as grade A, B, or C. Relaparotomy is mandatory for POPF associated with sepsis or hemorrhage (grade C). Peripancreatic drainage and completion pancreatectomy are the procedures most commonly used, but associated morbidity and mortality remain high. We hypothesized that the results of pancreatogastrostomy (PG) for treatment of grade C POPF following PD with PJ in the rare patients for whom relaparotomy is necessary would be similar to the results in a historical series of similar patients who underwent completion pancreatectomy. ⋯ In selected patients, salvage PG can be considered a safe and efficient alternative to completion pancreatectomy for the treatment of grade C POPF after PD with PJ.
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Review Meta Analysis Comparative Study
Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis.
To determine whether interventional radiology (IR) or laparotomy (LAP) is the best management of delayed postoperative hemorrhage (DPH) after pancreaticoduodenectomy. Data Source We undertook an electronic search of MEDLINE and selected for analysis only original articles published between January 1, 1990, and December 31, 2007. ⋯ This meta-analysis, although based on data from small case series, is unable to demonstrate any significant difference between LAP and IR in the management of DPH after pancreaticoduodenectomy. The management of this life-threatening complication is difficult, and the appropriate treatment pathway ultimately will be decided by the clinical status of the patient and the institution preference.
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Comparative Study
Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases.
To compare the volumetric increase of segments 2 and 3, segment 4, and the caudate lobe after portal vein ligation (PVL) and portal vein embolization (PVE). The small size of the remnant liver and chemotherapy-induced liver injury increase the risk of postoperative hepatic insufficiency after major hepatic resection for colorectal liver metastases. Portal vein ligation has been suggested to be less effective than embolization in inducing hypertrophy of the remnant liver. ⋯ Portal vein ligation is as effective as PVE in inducing hypertrophy of the remnant liver volume.