Liver, biliary system and pancreas
Michael Gaunt, Tjun Tang, Stewart Walsh in General Surgery Outpatient Decisions, 2018
Development of complications, including the following. ∝ Lower bile duct obstruction: ERCP to exclude other causes and cancer. Relief of obstruction may relieve the pain.∝ Duodenal obstruction: rare in chronic pancreatitis. Exclude cancer by biopsy. Treat non-cancerous cases by gastrojejunostomy.∝ Vascular involvement: pseudoaneurysms and portal hypertension.∝ Pancreatic cysts, pseudocysts, abscess, pancreatic ascites and pleural effusions.∝ Presence of a dominant mass leading to suspicion or fear of cancer.∝ Portal vein compression/mesenteric vein thrombosis.∝ Pancreatic duct stricture with upstream dilatation with or without pancreatic duct stones.∝ Colonic stricture.
Obese Patient (BMI 32) with Reflux Disease and Diabetes Mellitus
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
The authors’ preference for the Roux limb is an antecolic antegastric pathway as opposed to retrocolic retrogastric. This eliminates the potential for an internal hernia at the mesocolon. The surgeon, however, should be able to perform a retrocolic and retrogastric approach if there is too much tension on the gastrojejunostomy with an antecolic approach. The enteroenterostomy, or side-to-side jejunojejunostomy, is performed using a single fire of a 60 mm EndoGIA tan stapler. Anchoring sutures are used to align the two lengths of small bowel with the stapler. The remaining enterotomy is closed with a running 2-0 polyglyconate suture. The small bowel is then divided using another EndoGIA 60 mm tan stapler separating the Roux limb from the enteroenterostomy (Figure 8.3). Most surgeons would then believe that the jejunal and Petersen’s space need to be closed with a 2-0 non-absorbable suture, although evidence for this is still inconclusive.
Complications of Gastric Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Marginal ulcers typically are another common complication occurring in up to 16% of patients.39 Patients present with epigastric pain, nausea, vomiting, or dysphagia, and the diagnosis is typically made by endoscopy. Treatment is primarily medical with most responding to proton pump inhibitors, and documentation of healing by endoscopy is recommended. Surgery is indicated only for intractability or gastrogastric fistula usually requiring revision of the anastomosis. Like marginal ulceration, gastrojejunostomy stricture presents with postprandial vomiting and in some cases pain. The diagnosis is by endoscopy, and most cases will respond to balloon dilation; however, several sessions may be required.40
Primary gastric lymphoma: A report of 16 pediatric cases treated at a single institute and review of the literature
Published in Pediatric Hematology and Oncology, 2020
Nilgün Kurucu, Canan Akyüz, Bilgehan Yalçın, İnci Y. Bajin, Ali Varan, Diclehan Orhan, İbrahim Karnak, Burça Aydın, Tezer Kutluk
In total, 11 patients underwent exploratory laparotomy. Six of them were found to be inoperable, and only biopsy was done. Gastrojejunostomy was performed without resection of the tumor in another patient. Furthermore, in Patient 5, solitary perforation over the gastric body was observed during surgery. The perforation was repaired, and gastrojejunostomy was performed. Subtotal gastrectomy with gastroduodenostomy or gastrojejunostomy was performed in three other patients. Five patients received radiotherapy to the tumor location. In Patient 7, radiotherapy was applied after two courses of chemotherapy because of progressive disease and obstructive jaundice. Chemotherapy could not be continued in Patient 11 because of severe hematological toxicity, and radiotherapy was applied. All patients except two were treated with various chemotherapeutic regimens including LSA2L2 and LMB protocols, depending on year of diagnosis and histopathological subtypes. Malignant lymphoid proliferation in the patient with MZL was resolved after H. pylori eradication.
Quality of life after total pancreatectomy with islet autotransplantation for chronic pancreatitis in Japan
Published in Islets, 2023
Tadashi Takaki, Daisuke Chujo, Toshiaki Kurokawa, Akitsu Kawabe, Nobuyuki Takahashi, Kyoji Ito, Koji Maruyama, Fuyuki Inagaki, Koya Shinohara, Kumiko Ajima, Yzumi Yamashita, Hiroshi Kajio, Mikio Yanase, Chihaya Hinohara, Makoto Tokuhara, Yukari Uemura, Yoshihiro Edamoto, Nobuyuki Takemura, Norihiro Kokudo, Shinichi Matsumoto, Masayuki Shimoda
All patients underwent TP, which was performed using the standard technique. The pancreas was often atrophic, fibrotic, hard, and adherent to the surrounding tissue. The splenic artery and/or gastroduodenal artery were preserved until just before pancreatic resection to minimize the warm ischemia time. The spleen was resected in all cases. The pancreas was transported by the two-layer method28 after intraductal organ preservation29 and delivered to the cell processing facility for islet isolation. The gastrointestinal tract was reconstructed by simultaneous gastrojejunostomy and choledochojejunostomy. If necessary, a jejunal tube was placed for postoperative nutritional support. The patient then remained in the operating room with an open abdomen until islet transplantation.
Percutaneous Endoscopic Necrosectomy (PEN) Combined with Percutaneous Catheter Drainage (PCD) and Irrigation for the Treatment of Clinically Relevant Pancreatic Fistula after Pancreatoduodenectomy
Published in Journal of Investigative Surgery, 2020
Jian Lin, Biqing Ni, Guozhong Liu
Bartoli et al. succeeded in treating patients who suffered from grade B pancreatic fistula after PD by using endoscopic double-pigtail stents for drainage [29]. Futagawa Y et al. treated POPF and postoperative peripancreatic fluid collection with endoscopic ultrasound guided transgastric drainage (EUS-GD), and had high technical and clinical success rates [30]. These useful methods transgastric approach had some advantages compared with our combination therapy method: First, the procedure did not need repeated section of the abdominal wall. Second, the procedure had no extracorporeal facilities such as drainage tube and pack, and improved the quality of patients' life. Third, in cases when the puncture route for PCD is difficult to establish, the transgastric approach is feasible and safe [30]. However, the transgastric approach for the treatment of patients suffering from CR-POPF after PD may have some potential complications. The gastroscope manipulation may injure the stomach itself and the poorly healing gastrojejunostomy anastomosis, then aggravate the gastrojejunostomy anastomosis fistula. The gas injection during the gastroscope manipulation may induce air embolism. After the drainage established, the gastric contents and gastric acid may regurgitate into the area of the collection, which may exacerbate the infection and cause erosion of the structure around the anastomosis. Furthermore, the gastroscope manipulation was restricted by the distance from the gastric wall to the collection to reduce the risk of free perforation.
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