1
|
Yuan B, Zhang X, Kong C, Zhang C, Li H. Application of laparoscopic backtracking full-thickness continuous everting suture for non-AOSC choledocholithiasis. BMC Surg 2023; 23:315. [PMID: 37848861 PMCID: PMC10583331 DOI: 10.1186/s12893-023-02222-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Based on the current trend of increasing incidence of choledocholithiasis, it is of great significance to explore the closure method of the common bile duct during laparoscopic choledocholithotomy. METHODS Backtracking full-thickness continuous everting suture was selected for primary closure of the common bile duct suture, while traditional T-tube drainage was selected for the control group. Propensity score matching (PSM) was used to reduce baseline differences between the two groups. RESULT The intraoperative blood loss, operation time, postoperative recovery speed, postoperative bleeding, postoperative pancreatitis, recurrence rate of bile duct stones, and hospitalization time in the primary closure group were all less than those in the T-tube drainage group. CONCLUSION Under certain conditions, backtracking full-thickness continuous everting suture could benefit patients with choledocholithiasis compared with traditional T-tube drainage.
Collapse
Affiliation(s)
- Bo Yuan
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Xuanfeng Zhang
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Chenchen Kong
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Cancan Zhang
- Department of Gastroenterology and Endocrinology, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Huansong Li
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| |
Collapse
|
2
|
Pagnanelli M, De Gaetano F, Nappo G, Capretti G, Costantino ML, Zerbi A. The Choice of the Most Appropriate Suture Threads for Pancreatic Anastomoses on the Basis of Their Mechanical Characteristics. Biomedicines 2023; 11:biomedicines11041055. [PMID: 37189673 DOI: 10.3390/biomedicines11041055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
The choice of the most appropriate suture threads for pancreatic anastomoses may play an important role in reducing the incidence of post-operative pancreatic fistula (POPF). The literature on this topic is still not conclusive. The aim of this study was to analyze the mechanical characteristics of suture materials to find the best suture threads for pancreatic anastomoses. A single-axial electromagnetic actuation machine was used to obtain the stress–deformation relationship curves and to measure both the ultimate tensile strength (UTS) and the Young’s modulus at the 0–3% deformation range (E0–3) of four different suture materials (Poliglecaprone 25, Polydioxanone, Polyglactin 910, and Polypropylene) at baseline and after incubation in saline solution, bile, and pancreatic juice for 1, 3, and 7 days. Polydioxanone and Polypropylene showed stable values of UTS and E0–3 in all conditions. Polyglactin 910 presented significant UTS and E0–3 variations between different time intervals in all types of liquids analyzed. Poliglecaprone 25 lost half of its strength in all biological liquids analyzed but maintained low E0–3 values, which could reduce the risk of lacerations of soft tissues. These results suggest that Polydioxanone and Poliglecaprone 25 could be the best suture materials to use for pancreatic anastomoses. In vivo experiments will be organized to obtain further confirmations of this in vitro evidence.
Collapse
|
3
|
Ye H, Chen R, Xiao W, Lian X, Yang H. Polyester 5-0 suture for porous implant placement after retinoblastoma enucleation: analysis of 120 sockets. BMC Ophthalmol 2023; 23:30. [PMID: 36690980 PMCID: PMC9869537 DOI: 10.1186/s12886-023-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Techniques used to suture the rectus muscle to the implant can influence the implant-related complications which is still a major problem following retinoblastoma enucleation. The goals of this work were to report the efficacy among patients with retinoblastoma who underwent enucleation followed by porous implant placement with the rectus muscles sutured with 5-0 polyester suture. METHODS This was a retrospective study of consecutive patients with retinoblastoma who underwent primary enucleation and porous implant placement with the rectus muscles tagged and sutured to the implant with polyester 5-0 suture. All the patients were followed up for a minimum of 2 years. The main outcome measure was implant exposure. The secondary efficacy measures were other implant-related complications. RESULTS Between May 2016 and December 2018, a total of 120 patients (120 eyes) underwent primary enucleation and porous implant placement were included. Postoperatively, 10/120 (8.3%) eyes developed exposure or conjunctival granuloma. Exposure was the most common postoperative complication (7/10, 70.0%). There were no cases of implant extrusion, migration, or infection. CONCLUSIONS Polyester 5-0 sutures are successful in patients with retinoblastoma who underwent enucleation followed by porous implant placement. Complications are minimal. Polyester 5-0 sutures were not associated with unacceptable complications in this pediatric population.
Collapse
Affiliation(s)
- Huijing Ye
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060 China
| | - Rongxin Chen
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060 China
| | - Wei Xiao
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060 China
| | - Xiufen Lian
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060 China
| | - Huasheng Yang
- grid.12981.330000 0001 2360 039XState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060 China
| |
Collapse
|
4
|
Single-layer continuous duct-to-mucosa pancreaticojejunostomy: “how we do it”. Langenbecks Arch Surg 2022; 407:2151-2159. [DOI: 10.1007/s00423-021-02390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/28/2021] [Indexed: 10/18/2022]
|
5
|
Casciani F, Bassi C, Vollmer CM. Decision points in pancreatoduodenectomy: Insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula. Surgery 2021; 170:889-909. [PMID: 33892952 DOI: 10.1016/j.surg.2021.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/25/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite abundant, high-level scientific evidence, there is no consensus regarding the prevention, mitigation, and management of clinically relevant pancreatic fistula after pancreatoduodenectomy. The aim of the present investigation is three-fold: (1) to analyze the multiple decision-making points for pancreatico-enteric anastomotic creation and fistula mitigation and management after pancreatoduodenectomy, (2) to reveal the practice of contemporary experts, and (3) to indicate avenues for future research to reduce the burden of clinically relevant pancreatic fistula. METHODS A 109-item questionnaire was sent to a panel of international pancreatic surgery experts, recognized for their clinical and scientific authority. Their practice habits and thought processes regarding clinically relevant pancreatic fistula risk assessment, anastomotic construction, application of technical adjuncts, and mitigation strategies, as well as postoperative management, was explored. Sixteen clinical vignettes were presented to reveal their certain approaches to unique situations-both common and uncommon. RESULTS Sixty experts, with a cumulative 48,860 pancreatoduodenectomies, completed the questionnaire. Their median pancreatectomy/pancreatoduodenectomy case volume was 1,200 and 705 procedures, respectively, with a median career duration of 22 years and 200 indexed publications. Although pancreatico-jejunostomy reconstruction with transperitoneal drainage is the standard operative approach for most authorities, uncertainty emerges regarding the employment of objective risk stratification and adaptation of practice to risk. Concrete suggestions are offered to inform decision-making in intimidating circumstances. Early drain removal is frequently embraced, while a step-up approach is unanimously invoked to treat severe clinically relevant pancreatic fistula. CONCLUSION A comprehensive conceptual framework of 4 sequential phases of decision-making is proposed-risk assessment, anastomotic technique, mitigation strategy employment, and postoperative management. Basic science studies and outcome analyses are proposed for improvement.
Collapse
Affiliation(s)
- Fabio Casciani
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Surgery, University of Verona, Italy. https://twitter.com/F_Casciani
| | - Claudio Bassi
- Department of Surgery, University of Verona, Italy. https://twitter.com/pennsurgery
| | - Charles M Vollmer
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| |
Collapse
|
6
|
Giuliani T, Di Gioia A, Andrianello S, Marchegiani G, Bassi C. Pancreatoduodenectomy associated with colonic resections: indications, pitfalls, and outcomes. Updates Surg 2021; 73:379-390. [PMID: 33582983 DOI: 10.1007/s13304-021-00996-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
Pancreatoduodenectomy (PD) associated with colonic resections (CR) (PD-CR) might be a viable option in case of locally advanced periampullary tumors or right colon cancer. The aim of this review was to reappraise the indications and outcomes of PD-CR focusing on the occurrence of postoperative pancreatic fistula (POPF) and colonic anastomotic leak (CAL). A systematic literature search was performed in Medline and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published between 2000 and 2020 concerning PD-CR for periampullary or colonic neoplasms. Twenty-seven studies were selected. Morbidity after PD-CR ranged from 12 to 65% and surgery-related mortality was approximately 10%. When reported, the rates of POPF and AL were as high as 40% and 33%, respectively. The oncological results were strictly linked to the nature of the primary tumor and did not significantly differ from those achieved with standard resections. Surgical radicality and nodal status resulted the main determinants of outcome for pancreatic and colonic cancer, respectively. Solid evidence about the surgical outcomes of PD-CR is lacking, mainly due to the small proportion of patients undergoing such combined resection. Given the elevated surgical risk, a multidisciplinary evaluation is recommended for patient's selection. The increasing use of neoadjuvant therapies is expected to further change the indications and outcomes of PD-CR in the next future.
Collapse
Affiliation(s)
- Tommaso Giuliani
- Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, P.le A. Scuro 10, 37134, Verona, Italy.
| | - Anthony Di Gioia
- Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, P.le A. Scuro 10, 37134, Verona, Italy
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, P.le A. Scuro 10, 37134, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, P.le A. Scuro 10, 37134, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, P.le A. Scuro 10, 37134, Verona, Italy
| |
Collapse
|
7
|
Andrianello S, Marchegiani G, Malleo G, Allegrini V, Pulvirenti A, Giardino A, Butturini G, Girelli R, Salvia R, Bassi C. Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case-control, risk-adjusted analysis. HPB (Oxford) 2018; 20:977-983. [PMID: 29853432 DOI: 10.1016/j.hpb.2018.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/17/2018] [Accepted: 04/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is wide variability in the use of suture material for pancreatic anastomosis after pancreaticoduodenectomy (PD). This study evaluates the role of suture material on clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticojejunostomy (PJ) in a risk-adjusted setting. METHODS A retrospective study comparing (polyester) PE with polydioxanone (PDO) in 520 PDs. Patients were matched for risk for CR-POPF according to the fistula risk score (FRS) with the propensity score. RESULTS The matched PE and PDO groups consisted of 232 patients. The incidence of CR-POPF was lower for PE group (11.6 vs. 22%, p<0.01), with a lower rate of grade B (10.3 vs. 15.5%, p<0.01) and C (1.3 vs. 6.5%, p<0.01). After stratifying by fistula risk zone, PE suture remained associated with a reduced incidence of CR-POPF (9.4 vs. 15.6% low-, p = 0.04; 15.6 vs. 28.1% intermediate-, p = 0.02; 16.7 vs. 83.3% high-risk zone, p<0.01, respectively). Multivariable analysis demonstrated that pancreatic texture, preoperative diagnosis, FRS and the use of PE sutures were independent predictors of CR-POPF. CONCLUSIONS In the setting of a case-control matched for risk analysis, the use of PE suture for PJ is associated with a significant reduction of CR-POPF.
Collapse
Affiliation(s)
- Stefano Andrianello
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy
| | - Giovanni Marchegiani
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy
| | - Giuseppe Malleo
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy
| | - Valentina Allegrini
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy
| | - Alessandra Pulvirenti
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy
| | - Alessandro Giardino
- Department of Hepato-Pancreatico-Biliary Surgery - Casa di Cura Pederzoli, Peschiera del Garda, Italy
| | - Giovanni Butturini
- Department of Hepato-Pancreatico-Biliary Surgery - Casa di Cura Pederzoli, Peschiera del Garda, Italy
| | - Roberto Girelli
- Department of Hepato-Pancreatico-Biliary Surgery - Casa di Cura Pederzoli, Peschiera del Garda, Italy
| | - Roberto Salvia
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy.
| | - Claudio Bassi
- Department of Surgery and Oncology, General and Pancreatic Surgery - The Pancreas Institute, University of Verona Hospital, Italy
| |
Collapse
|