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Liu ZJ, Hong JY, Zhang C, She J, Zhai HH. Gastrointestinal bleeding after pancreatoduodenectomy: Report of four cases. World J Gastrointest Surg 2025; 17:100119. [DOI: 10.4240/wjgs.v17.i1.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/16/2024] [Accepted: 10/18/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy. We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.
CASE SUMMARY The main symptoms included black stool, hematochezia, haematemesis, blood in the nasogastric tube, and hemorrhagic shock. The mean age was 66.25 years old and the median onset time was 340 d after the surgery. The bleeding location comprised gastrointestinal anastomosis, bile duct-jejunum anastomosis, and extraluminal bleeding. The possible causes included marginal ulcer, jejunal varix, and abdominal infection. Endoscopic hemostatic clips, as well as a covered stent using angiography, were utilized to stop the bleeding and three patients survived. Only one patient died of gastrointestinal bleeding, abdominal bleeding, abdominal infection, hypovolemic shock, and disseminated intravascular coagulation.
CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
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Affiliation(s)
- Zi-Jin Liu
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jia-Yi Hong
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chao Zhang
- Department of Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing She
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hui-Hong Zhai
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Longo F, Panza E, Rocca L, Biffoni B, Lucinato C, Cintoni M, Mele MC, Papa V, Fiorillo C, Quero G, De Sio D, Menghi R, Alfieri S, Langellotti L. Enhanced Recovery After Surgery (ERAS) in Pancreatic Surgery: The Surgeon's Point of View. J Clin Med 2024; 13:6205. [PMID: 39458155 PMCID: PMC11508928 DOI: 10.3390/jcm13206205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 10/08/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
Pancreatic surgery is complex and associated with higher rates of morbidity and mortality compared to other abdominal surgeries. Over the past decade, the introduction of new technologies, such as minimally invasive approaches, improvements in multimodal treatments, advancements in anesthesia and perioperative care, and better management of complications, have collectively improved patient outcomes after pancreatic surgery. In particular, the adoption of Enhanced Recovery After Surgery (ERAS) recommendations has reduced hospital stays and improved recovery times, as well as post-operative outcomes. The aim of this narrative review is to highlight the surgeon's perspective on the ERAS program for pancreatic surgery, with a focus on its potential advantages for perioperative functional recovery outcomes.
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Affiliation(s)
- Fabio Longo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Edoardo Panza
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Lorenzo Rocca
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Beatrice Biffoni
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Chiara Lucinato
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Marco Cintoni
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valerio Papa
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Davide De Sio
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Roberta Menghi
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Lodovica Langellotti
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
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Wang Z, Liu C, Hu K, Zuo M, Tian Z, Wei Y, Zhou Q, Li Q. Postoperative delayed gastric emptying: may gut microbiota play a role? Front Cell Infect Microbiol 2024; 14:1449530. [PMID: 39193506 PMCID: PMC11347441 DOI: 10.3389/fcimb.2024.1449530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
Postoperative delayed gastric emptying is a prevalent complication following surgical procedures, imposing heavy physical and financial burdens on patients. However, current treatment options remain suboptimal. In recent years, an increasing number of studies have highlighted that the gut microbiota and its metabolites are closely associated with postoperative complications. Various factors can disrupt the gut microbiome after surgery. This review discusses the potential mechanisms by which the gut microbiota and their metabolites may contribute to the pathogenesis of postoperative delayed gastric emptying. However, the current knowledge base is limited in terms of fully understanding the exact mechanisms involved. It is therefore evident that further research is required to fully elucidate the role of the gut microbiome in postoperative delayed gastric emptying, with the aim of uncovering new possibilities for preventive measures and therapeutic treatments.
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Affiliation(s)
- Zhiyi Wang
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
- Department of Oncology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chuanbo Liu
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
| | - Kaiwen Hu
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
| | - Minghuan Zuo
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
| | - Zhen Tian
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
| | - Yue Wei
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
| | - Qin Zhou
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
| | - Quanwang Li
- Graduate School of Beijing, University of Chinese Medicine, Beijing, China
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Fan S, Chen G, Zhang K, Zhao L, Yuan H, Wu J, Gao W, Wei J, Xi C, Guo F, Chen J, Lu Z, Jiang K, Miao Y, Xiao B. The incidence and risk factors of marginal ulcers in the short and medium term in symptomatic post-pancreaticoduodenectomy patients ---- single-center experience. Am J Surg 2024; 233:94-99. [PMID: 38369416 DOI: 10.1016/j.amjsurg.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Marginal ulcer (MU) is one of the postoperative complications of pancreaticoduodenectomy (PD), which needs particular attention in postoperative treatments. METHODS The data of 190 patients who underwent PD and follow-up gastroscopic review due to upper GI symptoms within two years were retrospectively analyzed. The incidence of MU and risk factors were analyzed based on personal history, surgical procedure, past medical history, postoperative complications, and other relevant indicators. RESULTS The proportion of MU in patients who underwent endoscopic follow-up for upper gastrointestinal symptoms in the postoperative period in this cohort was 10.5% (20/190). Advanced age (69y vs. 59y, P = 0.012), alcohol consumption (20% vs. 8.2%, P = 0.03), and cigarette smoking (35% vs. 14.7%, P = 0.022) were associated with an increased incidence of MU. Longer surgery time (276.5min vs. 240min, P = 0.049), postoperative bleeding (10% vs. 1.8%, P = 0.030), and failure to take antacid regularly postoperatively (75% vs. 97.1%, P = 0.000) would increase the risk of MU; taking antacid regularly was an independent protective factor for postoperative anastomotic ulceration (OR: 0.091, CI: 0.022-0.383, P = 0.001). CONCLUSION Advanced age, alcohol consumption, smoking, longer operation time, or postoperative extraluminal hemorrhage are associated with MU. Regular use of antacids is an independent protective factor against the development of MU.
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Affiliation(s)
- Shaoqin Fan
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Guosheng Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kai Zhang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Li Zhao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hao Yuan
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chunhua Xi
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Feng Guo
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jianmin Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zipeng Lu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bin Xiao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Charpiat B. Letter to the editor regarding body mass index associated with overall complications and higher risk of delayed gastric emptying stated in the paper of Panni U et al. HPB (Oxford) 2023; 25:1278. [PMID: 37414711 DOI: 10.1016/j.hpb.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Bruno Charpiat
- Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France.
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