|
1
|
Atay A, Dilek ON. Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review. World J Gastrointest Surg 2021; 13:1497-1508. [PMID: 34950436 PMCID: PMC8649556 DOI: 10.4240/wjgs.v13.i11.1497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The omentum is an organ that is easily sacrificed during abdominal surgery. The scope of omentectomy and whether a routine omentectomy should be performed are still unknown.
AIM To review the literature in order to determine the physiological functions of the omentum and the roles it plays in pathological events in order to reveal the necessity for removal and preservation of the omentum.
METHODS A clinical review of the English language literature based on the MEDLINE (PubMed) database was conducted using the keywords: “abdomen”, “gastrointestinal”, “tumor”, “inflammation”, “omental flap”, “metastasis”, “omentum”, and “omentectomy”. In addition, reports were also identified by systematically reviewing all references in retrieved papers.
RESULTS The omentum functions as a natural barrier in areas where pathological processes occur in the abdominal cavity. The omentum limits and controls inflammatory and infectious pathologies that occur in the abdomen. It also aids in treatment due to its cellular functions including lymphatic drainage and phagocytosis. It shows similar behavior in tumors, but it cannot cope with increasing tumor burden. The stage of the disease changes due to the tumor mass it tries to control. Therefore, it is considered an indicator of poor prognosis. Due to this feature, the omentum is one of the first organs to be sacrificed during surgical procedures. However, there are many unknowns regarding the role and efficacy of the omentum in cancer.
CONCLUSION The omentum is a unique organ that limits and controls inflammatory processes, foreign masses, and lesions that develop in the abdominal cavity. Omental flaps can be used in all anatomical areas, including the thorax, abdomen, pelvis, and extremities. The omentum is an organ that deserves the title of the abdominal policeman. It is generally accepted that the omentum should be removed in cases where there is tumor invasion. However, the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.
Collapse
Affiliation(s)
- Arif Atay
- Department of Surgery, İzmir Katip Celebi University School of Medicine, Atatürk Education and Research Hospital, İzmir 35150, Turkey
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University School of Medicine, Atatürk Education and Research Hospital, İzmir 35150, Turkey
| |
Collapse
|
|
2
|
Yang Y, Fu X, Cai Z, Qiu Y, Mao L. The Occurrence of Klebsiella pneumoniae in Drainage Fluid After Pancreaticoduodenectomy: Risk Factors and Clinical Impacts. Front Microbiol 2021; 12:763296. [PMID: 34764948 PMCID: PMC8576322 DOI: 10.3389/fmicb.2021.763296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 12/07/2022] Open
Abstract
To investigate the risk factors and clinical impacts of the occurrence of Klebsiella pneumoniae isolated from drainage fluid in patients undergoing pancreaticoduodenectomy (PD). Clinicopathological data of all patients who underwent PD from January 2018 to March 2021 were analyzed retrospectively. The univariate and multivariate analyses were performed to identify independent risk factors for the occurrence of K. pneumoniae in drainage fluid and its clinical impacts on postoperative complications. Of the included 284 patients, 49 (17.2%) patients isolated K. pneumoniae in drain samples after PD. Preoperative biliary drainage (OR = 1.962, p = 0.037) independently predicted the contamination of K. pneumoniae in drain samples after PD. The rate of clinically relevant postoperative pancreatic fistula (CR-POPF), major complications (Clavien–Dindo Grade ≥ III), post-pancreatectomy hemorrhage (PPH), organ/space surgical site infection (SSI), and biliary leakage (BL) were significantly higher in K. pneumoniae positive group both in the univariate and multivariate analyses. Preventive measures and treatments for combating K. pneumoniae contamination may be beneficial to the perioperative outcomes of patients after PD.
Collapse
Affiliation(s)
- Yifei Yang
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Fu
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Zhenghua Cai
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yudong Qiu
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Liang Mao
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
|
3
|
Saito Y, Takahashi T, Obata Y, Nishida T, Ohkubo S, Nakagawa F, Serada S, Fujimoto M, Ohkawara T, Nishigaki T, Sugase T, Koh M, Ishida T, Tanaka K, Miyazaki Y, Makino T, Kurokawa Y, Nakajima K, Yamasaki M, Hirota S, Naka T, Mori M, Doki Y. TAS-116 inhibits oncogenic KIT signalling on the Golgi in both imatinib-naïve and imatinib-resistant gastrointestinal stromal tumours. Br J Cancer 2020; 122:658-667. [PMID: 31857719 PMCID: PMC7054534 DOI: 10.1038/s41416-019-0688-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/16/2019] [Accepted: 11/28/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite the effectiveness of imatinib mesylate (IM), most gastrointestinal stromal tumours (GISTs) develop IM resistance, mainly due to the additional kinase-domain mutations accompanied by concomitant reactivation of KIT tyrosine kinase. Heat-shock protein 90 (HSP90) is one of the chaperone molecules required for appropriate folding of proteins such as KIT. METHODS We used a novel HSP90 inhibitor, TAS-116, which showed specific binding to HSP90α/β with low toxicity in animal models. The efficacy and mechanism of TAS-116 against IM-resistant GIST were evaluated by using IM-naïve and IM-resistant GIST cell lines. We also evaluated the effects of TAS-116 on the other HSP90 client protein, EGFR, by using lung cell lines. RESULTS TAS-116 inhibited growth and induced apoptosis in both IM-naïve and IM-resistant GIST cell lines with KIT activation. We found KIT was activated mainly in intracellular compartments, such as trans-Golgi cisternae, and TAS-116 reduced autophosphorylated KIT in the Golgi apparatus. In IM-resistant GISTs in xenograft mouse models, TAS-116 caused tumour growth inhibition. We found that TAS-116 decreased phosphorylated EGFR levels and inhibited the growth of EGFR-mutated lung cancer cell lines. CONCLUSION TAS-116 may be a novel promising drug to overcome tyrosine kinase inhibitor-resistance in both GIST and EGFR-mutated lung cancer.
Collapse
Affiliation(s)
- Yurina Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Yuuki Obata
- National Cancer Center Hospital, Tsukiji, Japan
| | | | | | | | | | | | | | - Takahiko Nishigaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahito Sugase
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiro Koh
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomo Ishida
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
|
4
|
Bacterial smear test of drainage fluid after pancreaticoduodenectomy can predict postoperative pancreatic fistula. Pancreatology 2019; 19:274-279. [PMID: 30718188 DOI: 10.1016/j.pan.2019.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It is widely accepted that postoperative pancreatic fistula (POPF) accompanied by bacterial infection results in a worse outcome than POPF alone. However, few studies evaluating predictive indicators of POPF have focused on bacterial infection. METHODS A consecutive 100 patients who underwent pancreaticoduodenectomy at our institute for periampullary disease were enrolled. POPF was assessed according to the International Study Group of Pancreatic Fistula consensus guidelines; grades B and C were defined as clinically relevant POPF (CR-POPF). The patients' characteristics, perioperative surgical factors, and laboratory data including the results of culture and smear testing performed using drainage fluid on postoperative days (PODs) 1 and 3 were analyzed. RESULTS The overall incidence of CR-POPF was 25%. Univariate analyses revealed that the factors associated with CR-POPF were male sex, soft pancreas, MPD diameter, higher serum C-reactive protein concentration and white blood cell count on POD 3, higher amylase concentration in drainage fluid, and culture and/or smear positivity of drainage fluid. Multivariate analysis newly revealed that the smear positivity of drainage fluid on POD 3 was the independent risk factors for CR-POPF (p = 0.027). CONCLUSIONS Smear positivity of drainage fluid on POD 3 after pancreaticoduodenectomy may be a new predictor of CR-POPF.
Collapse
|
|
5
|
Abstract
Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.
Collapse
Affiliation(s)
- James T Ross
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Hobart W Harris
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| |
Collapse
|
|
6
|
Buscher K, Wang H, Zhang X, Striewski P, Wirth B, Saggu G, Lütke-Enking S, Mayadas TN, Ley K, Sorokin L, Song J. Protection from septic peritonitis by rapid neutrophil recruitment through omental high endothelial venules. Nat Commun 2016; 7:10828. [PMID: 26940548 PMCID: PMC4785224 DOI: 10.1038/ncomms10828] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022] Open
Abstract
Acute peritonitis is a frequent medical condition that can trigger severe sepsis as a life-threatening complication. Neutrophils are first-responders in infection but recruitment mechanisms to the abdominal cavity remain poorly defined. Here, we demonstrate that high endothelial venules (HEVs) of the greater omentum constitute a main entry pathway in TNFα-, Escherichia coli (E. coli)- and caecal ligation and puncture-induced models of inflammation. Neutrophil transmigration across HEVs is faster than across conventional postcapillary venules and requires a unique set of adhesion receptors including peripheral node addressin, E-, L-selectin and Mac-1 but not P-selectin or LFA-1. Omental milky spots readily concentrate intra-abdominal E. coli where macrophages and recruited neutrophils collaborate in phagocytosis and killing. Inhibition of the omental neutrophil response exacerbates septic progression of peritonitis. This data identifies HEVs as a clinically relevant vascular recruitment site for neutrophils in acute peritonitis that is indispensable for host defence against early systemic bacterial spread and sepsis.
Collapse
Affiliation(s)
- Konrad Buscher
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster 48149, Germany
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
- Department of Nephrology and Rheumatology, University of Muenster, Muenster 48149, Germany
| | - Huiyu Wang
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster 48149, Germany
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
| | - Xueli Zhang
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster 48149, Germany
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
| | - Paul Striewski
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
- Institute for Computational and Applied Mathematics, University of Muenster, Muenster 48149, Germany
| | - Benedikt Wirth
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
- Institute for Computational and Applied Mathematics, University of Muenster, Muenster 48149, Germany
| | - Gurpanna Saggu
- Center for Excellence in Vascular Biology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Stefan Lütke-Enking
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster 48149, Germany
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
| | - Tanya N. Mayadas
- Center for Excellence in Vascular Biology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Klaus Ley
- Division of Inflammation Biology, La Jolla Institute for Allergy and Immunology, La Jolla, California 92037, USA
| | - Lydia Sorokin
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster 48149, Germany
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
| | - Jian Song
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster 48149, Germany
- Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster 48149, Germany
| |
Collapse
|
|
7
|
Preoperative internal biliary drainage increases the risk of bile juice infection and pancreatic fistula after pancreatoduodenectomy: a prospective observational study. Pancreas 2015; 44:465-70. [PMID: 25423556 DOI: 10.1097/mpa.0000000000000265] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of this study was to identify the most appropriate endoscopic biliary drainage method in patients with pancreatic head cancer. METHODS A prospectively collected database comprising 122 consecutive patients who underwent pancreatoduodenectomy, including 72 patients treated by endoscopic retrograde biliary drainage (ERBD) and 50 patients treated by endoscopic nasobiliary drainage (ENBD) procedures, was analyzed. RESULTS All bile cultures collected intraoperatively were positive in the ERBD group, and the positive rates of drainage fluid cultures on postoperative days 1, 3, and 5 and the incidence of postoperative abdominal abscess formation were significantly higher than those in the ENBD group. Moreover, ERBD was identified as an independent predictive factor for postoperative pancreatic fistula (POPF) formation (hazards ratio, 11.81; P < 0.001). The receiver operating characteristic curve analysis for the preoperative drainage period in the ERBD group revealed that the determined cutoff level for the onset of POPF was 29 days. CONCLUSIONS Endoscopic retrograde biliary drainage resulted in more frequent postoperative complications, including POPF, compared with ENBD. Postoperative pancreatic fistula is more likely to occur if the ERBD period exceeds 1 month in patients scheduled to undergo pancreatoduodenectomy.
Collapse
|
|
8
|
Yamashita K, Sasaki T, Itoh R, Kato D, Hatano N, Soejima T, Ishii K, Takenawa T, Hiromatsu K, Yamashita Y. Pancreatic fistulae secondary to trypsinogen activation by Pseudomonas aeruginosa infection after pancreatoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:454-62. [PMID: 25678202 DOI: 10.1002/jhbp.223] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/13/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pancreatic fistula after pancreatoduodenectomy (PD) is associated with high mortality and morbidity. Trypsinogen activation and bacteria, although hypothesized to be interrelated etiopathogenetically, have not had their relationship and pathogenic mechanisms elucidated. This study investigated bacterial involvement in pancreatic juice activation perioperatively after PD at sites of pancreatic fistula formation. METHODS Fifty patients underwent PD; postoperative pancreatic fistulae were graded based on the International Study Group for Pancreatic Fistula grading criteria. Bacteria were isolated from cultures of drainage fluid. Digested peptides from trypsinogen and bacterial culture supernatants underwent sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) separation and mass spectrometric analysis. Zymography was used to detect the trypsinogen activator. RESULTS Pseudomonas aeruginosa and Enterobacter cloacae isolated from drainage fluid in patients with grades B and C pancreatic fistulae could cause trypsinogen activation. Trypsinogen activation by P. aeruginosa and E. cloacae were preventable by the use of a serine protease inhibitor in vitro. A protease in the supernatant from P. aeruginosa-positive cultures acted as the trypsinogen activator. CONCLUSIONS Infection with P. aeruginosa perioperatively to PD entails secretion of a protease activator of trypsinogen to trypsin. Bacterial infection control in the perioperative PD period could be crucial to prevent development of pancreatic fistula.
Collapse
Affiliation(s)
- Kanefumi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takamitsu Sasaki
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Ryota Itoh
- Department of Microbiology and Immunology, Fukuoka University School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Daisuke Kato
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan
| | - Naoya Hatano
- Integrated Center for Mass Spectrometry, Kobe University, Kobe, Hyogo, Japan
| | - Toshinori Soejima
- Department of Microbiology and Immunology, Fukuoka University School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Kazunari Ishii
- Department of Microbiology and Immunology, Fukuoka University School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Tadaomi Takenawa
- Integrated Center for Mass Spectrometry, Kobe University, Kobe, Hyogo, Japan
| | - Kenji Hiromatsu
- Department of Microbiology and Immunology, Fukuoka University School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan
| |
Collapse
|
|
9
|
Migita K, Takayama T, Matsumoto S, Wakatsuki K, Tanaka T, Ito M, Nakajima Y. Impact of bacterial culture positivity of the drainage fluid during the early postoperative period on the development of intra-abdominal abscesses after gastrectomy. Surg Today 2014; 44:2138-45. [PMID: 24633956 DOI: 10.1007/s00595-014-0881-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/14/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to evaluate the impact of positive bacterial cultures of the drainage fluid (D-cultures) during the early postoperative period on the incidence of intra-abdominal abscess formation following gastrectomy. METHODS From January 2012 to June 2013, we prospectively performed D-cultures on postoperative day (POD) 1 in consecutive gastric cancer patients who underwent gastrectomy. The univariate and multivariate analyses were performed to identify the risk factors for intra-abdominal abscess formation without anastomotic leakage. RESULTS The rate of positive D-cultures was 6.4 % on POD 1. According to a univariate analysis, the use of combined organ resection (P = 0.011), the drain amylase level on POD 1 (P = 0.016) and the D-culture status on POD 1 (P = 0.004) were found to be significantly associated with the incidence of intra-abdominal abscesses. A multivariate analysis demonstrated that D-culture positivity on POD 1 was the only independent predictor of intra-abdominal abscess formation (P = 0.011). CONCLUSIONS The present study demonstrated that bacterial culture positivity of drainage fluid during the early postoperative period has a significant impact on the development of intra-abdominal abscesses after gastrectomy.
Collapse
Affiliation(s)
- Kazuhiro Migita
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan,
| | | | | | | | | | | | | |
Collapse
|
|
10
|
Campbell BG. Primary Omental Abscessation or Omental Infarction in Four Dogs. J Am Anim Hosp Assoc 2009; 45:168-75. [DOI: 10.5326/0450168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary omental abscessation was diagnosed in three dogs after laparotomy. Laparotomy was performed to explore an abdominal mass of unknown origin and chronic fat necrosis diagnosed in one dog as an incidental finding during ovariohysterectomy. Primarily hypoechoic masses not connected to any abdominal structures were visualized with abdominal ultrasound in three dogs. Suppurative inflammation was diagnosed from fine-needle aspirate evaluation in two dogs. Bacteria were cultured from two abscesses despite the absence of organisms on Gram stain, cytology, and histopathology. Foreign material was found in one abscess. All four dogs experienced weight loss and/or an episode of gastrointestinal signs. Primary omental abscessation may be preceded by omental vascular compromise and/or interaction of the omentum with foreign material.
Collapse
Affiliation(s)
- Bonnie G. Campbell
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610
- From the
| |
Collapse
|
|
11
|
Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Yamaue H. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 2006; 244:1-7. [PMID: 16794381 PMCID: PMC1570595 DOI: 10.1097/01.sla.0000218077.14035.a6] [Citation(s) in RCA: 360] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was designed to determine whether the period of drain insertion influences the incidence of postoperative complications. BACKGROUND DATA The significance of prophylactic drains after pancreatic head resection is still controversial. No report discusses the association of the period of drain insertion and postoperative complications. METHODS A total of 104 consecutive patients who underwent pancreatic head resection were enrolled in this study. To assess the value of prophylactic drains, we prospectively assigned the patients into 2 groups: group I underwent resection from January 2000 to January 2002 (n = 52, drain to be removed on postoperative day 8); group II underwent resection from February 2002 to December 2004 (n = 52, drain to be removed on postoperative day 4). Postoperative complications in the 2 groups were compared. RESULTS The rate of pancreatic fistula was significantly lower in group II (3.6%) than in group I (23%) (P = 0.0038). The rate of intra-abdominal infections, including intra-abdominal abscess and infected intra-abdominal collections, was significantly reduced in group II (7.7%) compared with group I (38%) (P = 0.0003). Eighteen of 52 (34.6%) patients in group I had an inserted drain beyond 8 days, whereas only 2 of 52 (3.7%) patients in group II had an inserted drain beyond 4 days (P = 0.0002). Cultures of drainage fluid were positive in 16 of 52 (30.8%) patients in group I, and in 2 of 52 (3.7%) patients in group II (P = 0.0002). Intraoperative bleeding (> 1500 mL), operative time (> 420 minutes, and the period of drain insertion were significant risk factors for intra-abdominal infections (P = 0.043, 0.025, 0.0003, respectively). The period of drain insertion was the only independent risk factor for intra-abdominal infections by multivariate analysis (odds ratio, 6.7). CONCLUSION Drain removal on postoperative day 4 was shown to be an independent factor in reducing the incidence of complications with pancreatic head resection, including intra-abdominal infections.
Collapse
Affiliation(s)
- Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
|
12
|
Abstract
Although we recommend the team approach for the treatment of pancreatic necrosis, we cannot support our method with evidence-based medicine. The few reports available (presented in this article) suggest an improvement by avoiding surgery in many cases and with a low mortality. Two important prerequisites are necessary to begin this team method. First is the assembly of a team, which requires years of recruitment using influence and leadership at centers of expertise in the treatment of pancreatic necrosis. Second, and possibly just as difficult as team assembly, is the design and use of a common algorithm that allows the reporting of data supported with the "power of n."
Collapse
Affiliation(s)
- Mehran Fotoohi
- Department of Radiology, Virginia Mason Medical Center, 1100 Ninth Avenue, PO Box 900 (C6-GSURG), Seattle, WA 98111, USA
| | | |
Collapse
|
|
13
|
Abstract
The close association between infection and poor outcome in severe pancreatitis has led many investigators to hypothesize that antibiotic prophylaxis might reduce infection and thereby reduce mortality. However, despite this possible relationship, few studies of good quality have been performed in humans. Comprehensive searches using Medline and reviewing relevant published bibliographies of English-language human and experimental literature concerning acute pancreatitis or pancreatic tissue and antibiotic therapy or pharmacokinetics were conducted. Ample experimental evidence indicates that aminoglycosides penetrate pancreatic tissue poorly and that penetration of penicillins is variable, although the relevance of this is debatable, because most tissue that requires debridement in severe pancreatitis is necrotic peripancreatic retroperitoneal fat, not the pancreas itself. Although several animal studies suggest that antibiotic prophylaxis would be beneficial in severe pancreatitis, two recent randomized studies of intravenous antibiotics in humans provide conflicting data. There are insufficient data to recommend the use of selective digestive decontamination. Some justification exists for the use of intravenous antibiotic prophylaxis in severe pancreatitis, but the data are insufficient to mandate prophylaxis or to elevate it to the standard of care. If chosen, prophylaxis with the combination of a fluoroquinolone plus metronidazole, or monotherapy with a carbapenem antibiotic, would be most appropriate. Several other questions-including the minimum degree of severity that will benefit, the validity of endpoints other than mortality, and reduction of the need for surgical drainage-require additional trials.
Collapse
Affiliation(s)
- P S Barie
- Department of Surgery, New York Hospital-Cornell Medical Center, New York, New York 10021, USA
| |
Collapse
|
|
14
|
Soper NJ, Brunt LM, Dunnegan DL, Meininger TA. Laparoscopic distal pancreatectomy in the porcine model. Surg Endosc 1994; 8:57-60; discussion 60-1. [PMID: 8153866 DOI: 10.1007/bf02909495] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Our aim was to assess the feasibility and safety of laparoscopic distal pancreatectomy in an animate model. After developing the technique in acute animal experiments, laparoscopic distal pancreatectomy was performed in five young domestic pigs. Five trocars were used (2-10 mm, 2-12 mm, 1-11 mm) for video laparoscopic access to the peritoneal cavity. The operations were performed without complication in 62-95 min (mean +/- SEM, 77 +/- 7 min). Each animal tolerated oral feedings on the first postoperative day and subsequently gained 6-11 kg (10 +/- 2 kg) in the 4-7-week interval prior to sacrifice. Although there was a significant increase in serum amylase on the first postoperative day, this was associated with a comparable increase in hematocrit, possibly representing hemoconcentration. The weight of the laparoscopically resected pancreatic segment ranged from 16 to 36 g (19 +/- 2 g) while that of the pancreatic head at sacrifice was 13-29 g (21 +/- 3 g). At the time of sacrifice, there were few intraabdominal adhesions and no evidence of fluid collection or pancreatitis. The staple line across the body of the pancreas was grossly intact in all animals. We conclude that laparoscopic distal pancreatectomy in the porcine model is feasible and safe. It may therefore be possible to perform laparoscopic distal pancreatectomy in humans.
Collapse
Affiliation(s)
- N J Soper
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110
| | | | | | | |
Collapse
|
|
15
|
Affiliation(s)
- S H Dougherty
- Department of Surgery, Texas Tech University School of Medicine, El Paso
| | | |
Collapse
|
|
16
|
Affiliation(s)
- S H Dougherty
- Department of Surgery, Texas Tech University School of Medicine, El Paso
| | | |
Collapse
|