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Zelga P, Rees J, Iaculli E, Johnson C, Jah A. Patient-reported outcomes after minimally invasive retroperitoneal pancreatic necrosectomy to treat acute pancreatitis: An exploratory study. J Dig Dis 2021; 22:604-614. [PMID: 34331420 DOI: 10.1111/1751-2980.13036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study (abbreviated as QUANTUM) was to assess the quality of life (QoL) of patients who underwent minimally invasive retroperitoneal pancreatic necrosectomy (MIRPN) for acute pancreatic necrosis with or without infection of necrotic tissue collections after discharge and to compare the patient-reported outcomes (PRO) in these patients with published data in normative population. METHODS Patients with acute pancreatitis who underwent MIRPN between January 2010 and December 2016 were identified and invited to complete the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC PAN28(CP) questionnaires. PRO were compared using Pearson correlation coefficient and ANOVA (significance P < 0.01) with an age- and sex-matched normative population of western Europe, stratified by age, and also the time duration after MIRPN (<3 y and >3 y). A change >15 points in the PRO score was taken as clinically important. RESULTS Among 52 eligible patients identified, 46 (88%) agreed to participate, 74% returned questionnaires. After the MIRPN all patients had worse physical and social functioning scores with a clinically important (>15 points) reduction in those ≤50 years; while fatigue, pain and insomnia symptom scales had the highest scores (42, 26 and 30 points, respectively). Patients <3 years after MIRPN had similar scores for all functional scales and global health-related quality of life (HRQoL) compared to the normative population. However, over time their global HRQoL deteriorated and after 3 years their scores for functioning and symptoms were statistically (P < 0.0001) and clinically (>15 points) worse than those in age-matched controls. CONCLUSIONS During the first 3 years after the MIRPN patients have a relatively high QoL but report worse fatigue than the normative population. However, patients should be informed that their HRQoL deteriorates with time, often due to chronic pancreatitis and pancreatic insufficiency. This study supports the use of MIRPN and prospective studies of HRQoL in this setting are indicated.
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Affiliation(s)
- Piotr Zelga
- Cambridge Hepatobiliary and Transplant Unit, Addenbrookes Hospital and University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan Rees
- Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Edoardo Iaculli
- Cambridge Hepatobiliary and Transplant Unit, Addenbrookes Hospital and University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Colin Johnson
- Surgical Unit, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Asif Jah
- Cambridge Hepatobiliary and Transplant Unit, Addenbrookes Hospital and University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Pandit N, Yadav TN, Awale L, Deo KB, Mahat B, Adhikary S. Open Pancreatic Necrosectomy Is Still Safe and Effective Treatment for Pancreatic Necrosis Managed by Step-Up Approach. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Niu DG, Li WQ, Huang Q, Yang F, Tian WL, Li C, Ding LA, Fang HC, Zhao YZ. Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study. BMC Gastroenterol 2020; 20:212. [PMID: 32640995 PMCID: PMC7341608 DOI: 10.1186/s12876-020-01343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). Methods Consecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation–suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN). Results The recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052). Conclusion ON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.
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Affiliation(s)
- Dong-Guang Niu
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Wei-Qin Li
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Qian Huang
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Fan Yang
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Wei-Liang Tian
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Chen Li
- Oncology Department, Xintai people's Hospital, Tai'an, 271200, Shandong, China
| | - Lian-An Ding
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Hong-Chun Fang
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Yun-Zhao Zhao
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China. .,Department of General Surgery, Jinling clinical college of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, 210000, Jiangsu, China.
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Parray AM, Mwendwa P, Mehrotra S, Mangla V, Lalwani S, Mehta N, Yadav A, Nundy S. A Review of 2255 Emergency Abdominal Operations Performed over 17 years (1996-2013) in a Gastrointestinal Surgery Unit in India. Indian J Surg 2016; 80:221-226. [PMID: 29973751 DOI: 10.1007/s12262-016-1567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 12/05/2016] [Indexed: 12/26/2022] Open
Abstract
There is little information regarding the clinical spectrum and outcome of emergency abdominal operations from specialized units in India. We examined these in our gastrointestinal surgery and liver transplantation unit from a prospective database maintained between July 1996 and April 2013. Out of 9966 operations performed, 2255 (26%) were emergency procedures (reoperations during the same admission, e.g., for necrotizing pancreatitis were excluded). The primary outcome was 30-day postoperative mortality. The mean age of the patients was 47 years (range 1-107) and included the following age groups: 0-18 years (n = 105, 4.7%); 19-64 years (n = 1766, 78.3%), and >65 years (n = 384, 17.0%). The majority were males (1609, 71%), and there were 646 females (29%). The most common indications were small bowel emergencies (598, 26.5%), followed by pancreatic (417, 18.5%) and colonic (281, 12.5%) emergencies. Pancreatic operations were the second commonest in the adult and middle aged group. Colorectal operations were the second commonest in the geriatric age group (>65 years). Emergency operations for other conditions were: postoperative complications following elective operations 171 (7.5%), gastroduodenal bleeding or perforation in 144 (6.3%), and liver surgery in 93 patients (4.1%) patients. In the small bowel emergencies, 223 patients (37.2%) had primary diagnosis of adhesive obstruction, gangrene in 135 patients (22.5%), perforation in 121 patients (20%), and fistula in 56 patients (9.3%). Mesenteric venous thrombosis was found to be the primary cause of small bowel emergencies, either as a primary cause in gangrene or as a secondary cause in perforations and adhesions. The postoperative mortality after emergencies was 12.6% compared to 2% in elective procedures. Mortality was significantly higher in males (14%) than females (9.6%), p < 0.005. Category wise mortality was as follows: pancreatic surgery (n = 86, 20.6%), surgery for postoperative complications (n = 33, 19.3%), duodenal surgery (n = 18, 12.5%), small intestinal surgery (n = 68, 11.4%), and colonic surgery (n = 35, 12.45%). Emergency operations comprise a significant proportion of a GI surgical unit's workload. The mortality is greatest after pancreatic operations followed by those done for postoperative complications. Despite advances in surgical and postoperative care, emergency operations for abdominal emergencies are associated with mortality which is six times higher compared to elective procedures.
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Affiliation(s)
- Amir Mushtaq Parray
- 1Department of Surgical Gastroenterology and Liver Transplant, Sir Ganga Ram Hospital, Room No. 1474, Sir Ganga Ram Hospital, New Delhi, India
| | - Peter Mwendwa
- 1Department of Surgical Gastroenterology and Liver Transplant, Sir Ganga Ram Hospital, Room No. 1474, Sir Ganga Ram Hospital, New Delhi, India
| | - Siddharth Mehrotra
- 2Sir Ganga Ram Hospital, Room No. 2222, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Mangla
- 2Sir Ganga Ram Hospital, Room No. 2222, Sir Ganga Ram Hospital, New Delhi, India
| | - Shailendra Lalwani
- 2Sir Ganga Ram Hospital, Room No. 2222, Sir Ganga Ram Hospital, New Delhi, India
| | - Naimish Mehta
- 2Sir Ganga Ram Hospital, Room No. 2222, Sir Ganga Ram Hospital, New Delhi, India
| | - Amitabh Yadav
- 2Sir Ganga Ram Hospital, Room No. 2222, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- 2Sir Ganga Ram Hospital, Room No. 2222, Sir Ganga Ram Hospital, New Delhi, India
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Szentkereszty Z, Balog K, Balázs L, Csiszkó A. [The treatment of walled-off pancreatic necrosis. Review]. Orv Hetil 2016; 157:1866-1870. [PMID: 27868439 DOI: 10.1556/650.2016.30509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Walled-off pancreatic necrosis is a late complication of severe acute pancreatitis that generally needs some interventions. The aim of this review is to analyse the indications, technical aspects and limits of these therapeutic options. The development of the walled-off pancreatic necrosis needs 4-6 weeks from the onset of the disease. The necrosectomy is recommended after this time. Endoscopic necrosectomy offers good results if the necrosis is in retrogastric or retroduodenal localisations. Open necrosectomy can be performed through the gastrocolic ligament or the mesocolon. It is suggested to complete necrosectomy with open or closed omental bursa drainage or packing. The transgastric necrosectomy does not need external drainage. Surgical procedures can be performed with laparoscopy either. In localized necrosis other minimal invasive approaches can be used. CONCLUSIONS In addition to the transluminal endoscopic or minimal invasive necrosectomies different types of surgical procedures has an important role in the treatment of walled-off pancreatic necrosis. Orv. Hetil., 2016, 157(47), 1866-1870.
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Affiliation(s)
- Zsolt Szentkereszty
- Klinikai Központ, Sebészeti Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Móricz Zs. krt. 22., 4032
| | - Klaudia Balog
- Klinikai Központ, Sebészeti Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Móricz Zs. krt. 22., 4032
| | - Lídia Balázs
- Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Adrien Csiszkó
- Klinikai Központ, Sebészeti Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Móricz Zs. krt. 22., 4032
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Khan KH, Khan MF, Khan TJ. Gastric perforation without generalized peritonitis; A very rare complication after necrosectomy for necrotizing pancreatitis. Pak J Med Sci 2016; 32:782-5. [PMID: 27375733 PMCID: PMC4928442 DOI: 10.12669/pjms.323.9726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/12/2016] [Indexed: 12/12/2022] Open
Abstract
Gastric perforation is a very rare complication of necrotizing pancreatitis. We present an interesting case of gastric perforation after necrosectomy for necrotizing pancreatitis without generalized peritonitis. Abdominal drain was seen inside the stomach on endoscopy and there were no clinical features of generalized peritonitis even after 10 days of surgery. Patient was re-explored. The drain was removed and stomach was primarily repaired. The patient recovered uneventfully and was discharged home on 6(th) post operative day. On follow-up visit after one month patient was doing very well and had no complications.
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Affiliation(s)
- Kamran Hakeem Khan
- Dr. Kamran Hakeem Khan, Registrar Department of Surgery, North West General Hospital & Research Center, North West General Hospital & Research Center, Hayatabad, Peshawar, Pakistan
| | - Mohammad Farid Khan
- Dr. Mohammad Farid Khan, FRCS. Consultant Department of General surgery, North West General Hospital & Research Center, North West General Hospital & Research Center, Hayatabad, Peshawar, Pakistan
| | - Tariq Jabbar Khan
- Dr. Tariq Jabbar Khan, FRCS. Consultant Department of General surgery, North West General Hospital & Research Center, Hayatabad, Peshawar, Pakistan
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Bingener J, Ibrahim-zada I. Natural orifice transluminal endoscopic surgery for intra-abdominal emergency conditions. Br J Surg 2013; 101:e80-9. [PMID: 24273005 DOI: 10.1002/bjs.9352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient benefits from natural orifice transluminal endoscopic surgery (NOTES) are of interest in acute-care surgery. This review provides an overview of the historical development of NOTES procedures, and addresses their current uses and limitations for intra-abdominal emergency conditions. METHODS A PubMed search was carried out for articles describing NOTES approaches for appendicectomy, percutaneous gastrostomy, hollow viscus perforation and pancreatic necrosectomy. Pertinent articles were reviewed and data on available outcomes synthesized. RESULTS Emergency conditions in surgery tax the patient's cardiovascular and respiratory systems, and fluid and electrolyte balance. The operative intervention itself leads to an inflammatory response and blood loss, thus adding to the physiological stress. NOTES provides a minimally invasive alternative access to the peritoneal cavity, avoiding abdominal wall incisions. A clear advantage to the patient is evident with the implementation of an endoscopic approach to deal with inadvertently displaced percutaneous endoscopic gastrostomy tubes and perforated gastroduodenal ulcer. The NOTES approach appears less invasive for patients with infected pancreatic necrosis, in whom it allows surgical debridement and avoidance of open necrosectomy. Transvaginal appendicectomy is the second most frequently performed NOTES procedure after cholecystectomy. The NOTES concept has provided a change in perspective for intramural and transmural endoscopic approaches to iatrogenic perforations during endoscopy. CONCLUSION NOTES approaches have been implemented in clinical practice over the past decade. Selected techniques offer reduced invasiveness for patients with intra-abdominal emergencies, and may improve outcomes. Steady future development and adoption of NOTES are likely to follow as technology improves and surgeons become comfortable with the approaches.
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Affiliation(s)
- J Bingener
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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