Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension
Aliaksandr Varabei,
Anatoli Shuleika,
Yury Vizhinis,
Yury Arlouski,
Natalia Lagodich
Issue:
Volume 3, Issue 4, August 2015
Pages:
32-38
Received:
29 June 2015
Accepted:
6 July 2015
Published:
17 July 2015
Abstract: Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser and double balloon enteroscopy (DBE) technologies for its relief. Materials and methods: Pancreatojejunoanastomosis (PJA) lumen was examined using the videoenteroscope EN-450P5/20 (Fujifilm group, Fujinon Co, Tokio, Japan) for the first time in the world. All 20 patients had had CP and underwent an elective surgery earlier. During 2010-2014, 198 resections were performed, with 159 (80,3%) being laser drainage procedures. Results: DBE revealed strictures of PJA and open common bile duct, residual pancreatoliths in PJA lumen, and PJA leakage. After DBE laser lithotripsy of pancreatoliths in tributary ducts, a free outflow of pancreatic juice from the lumen was obtained. DBE findings were supported by the morphological study of excised pancreatic specimen, CT-scans before the surgery and the staining of PJA lumen. All these data suggest that 17,7% of CP patients along with magistral ductal hypertension had peripheral ductal hypertension (PDH), which seems to be a new cause of severe abdominalgia. The latter arises when pancreatoliths block the orifices of tributary ducts. For reducing the PDH, we have developed a new surgical procedure named «laser cylindric wirsungectomy» (n=26) and proposed our own classification of pancreatic duct stones. Conclusions: DBE has great opportunities for the diagnosis of complications and their mini-invasive treatment after pancreatojejunostomy (PJ). Laser technologies are considered to be a new approach to the effective open and mini-invasive surgical treatment of CP.
Abstract: Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser ...
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Injuries Presentations in Laparoscopic Versus Open Cholecystectomy
Mohamed Salah Abdelhamid,
Ahmed Mohamed Sadat,
Ayman Hamdi Abouleid,
Amr Mohamed Aly Mohamed,
Mahmoud Ahmed Negida
Issue:
Volume 3, Issue 4, August 2015
Pages:
39-43
Received:
12 July 2015
Accepted:
22 July 2015
Published:
31 July 2015
Abstract: The wide acceptance of LC in the early 1990s was based on several case series rather than randomized controlled trials. Community awareness that a minimally invasive procedure could dramatically reduce postoperative pain and improve recuperation made it impractical to conduct trials that might have better refined the technique. This study was to recognize the actual complication risk associated with cholecystectomy. Included in the study were 1486 patients operated upon between Feb. 1999 and April. 2014. Open cholecystectomy done in 292 (19.6%) mostly in patients with contra-indications for laparoscopy, 1194 (80.4%) initiated laparoscopically, 1086[91%] completed laparoscopically and 108 (9%) converted to open procedure. There were eighteen (1.2%) patients with bile duct injury. One patient (0.3%) in the open procedure and seventeen (1.4%) in the laparoscopic procedure. Nine cases presented with intra-operative injury, two with early post operative jaundice, two with late post operative jaundice, five with post operative leak. The patients with recognized intra-operative injury were significantly not higher in the laparoscopic group of patients (P<0.3) than in the open procedure. The post operative jaundice was significantly high in the laparoscopic group of patients (P<0.045). The post operative leak was significantly higher in the laparoscopic group of patients than in the open procedure (P<0.028). In general post operative morbidity was high in the laparoscopic group of patients than in the open procedure (P<0.01). On the other hand, the post operative mortality were four times more in the open procedure and was statistically significant (P<0.04). Conclusion: The risk of complications after cholecystectomy was slightly higher than that found in literature; Laparoscopic cholecystectomy was associated with a higher incidence of CBD injuries, leak, jaundice and technical factors leading to failure to recognize injuries when they occur.
Abstract: The wide acceptance of LC in the early 1990s was based on several case series rather than randomized controlled trials. Community awareness that a minimally invasive procedure could dramatically reduce postoperative pain and improve recuperation made it impractical to conduct trials that might have better refined the technique. This study was to re...
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