Laparoscopic versus open pylorus-preserving pancreatoduodenectomy. The first meta-analyse of retrospective matched cases

Purpose: To compare the safety, feasibility, and short-term clinical benefits of laparoscopic pylorus-preserving pancreaticoduodenectomy (L-PPPD) to open pylorus-preserving pancreaticoduodenectomy (O-PPPD) through retrospective matched cases. Methods: Web of Science, Cochrane, PubMed, CNKI were searched systematically identify studies published between January and December 2017 comparing L-PPPD to O-PPPD. The meta-analysis was performed by using Review Manager 5.3.Results: Two studies matched the selection criteria, including 108 (50%) cases of laparoscopic pylorus-preserving pancreaticoduodenectomy and 108(50%) cases of open pylorus-preserving pancreaticoduodenectomy. None of the included studies were randomized, which were both retrospective matched cases. There was no difference in the incidence of postoperative pancreatic fistula, blood loss, diet start and lymph nodes. However, L-PPPD has a shorter hospital stay (p=0.0003) and O-PPPD has a shorter operative time (p=0.02) and tend to decrease the delayed gastric emptying.Conclusions: The perioperative safety of laparoscopic surgery, which also has advantages of minimal invasion and shorter hospital stay, is comparable to that of open surgery. Laparoscopic surgery could be operated if the patients matched the indication and operation difficulty is not so great. However, blind pursuits of L-PPPD should be restrained because there is no essential difference between these two in terms of feasibility, safety and short-term complication.(AU)

YU pyloroplasty for the correction of chronic hypertrophic pyloric gastropathy in canines / Piloroplastia em Y-U para a correção da gastropatia hipertrófica pilórica crônica em caninos

Background: One of the causes of delay gastric emptying is the chronic hypertrophic pyloric gastropathy, unusual disease that can occur in acquired or congenital form. It is characterized by hypertrophy of the antral mucosa, by thickening of the muscular layer, or by hyperplasia of the pylorus. The animals are presented with a history of chronic intermittent vomiting. Treatment is based on surgical correction through techniques such as pyloromyotomy or transverse or Y-U pyloroplasty. Thus, the aim was report three cases of pyloric stenosis by hypertrophy in dogs of the breeds, Fila Brasileiro, English Bull Terrier and American Pitbull Terrier, emphasizing the diagnosis and therapy instituted. Cases: All animals in this study reached the Veterinary Hospital of the Federal University of Mato Grosso with a history of chronic intermittent vomiting. The findings of physical and laboratory examinations in all animals were unspecific, with those important to rule out other causes of vomiting. Contrast radiographic evaluation revealed marked stomach distension and delayed gastric emptying, indicated gastric outflow obstruction. In one case, a video endoscopy was performed. The images reveal hyperemia of the gastric mucosa with small areas of bleeding around the stomach. It was observed intense production of gastric juice and the presence of the same reflux. In the pyloric antrum [...]

YU pyloroplasty for the correction of chronic hypertrophic pyloric gastropathy in canines / Piloroplastia em Y-U para a correção da gastropatia hipertrófica pilórica crônica em caninos

Background: One of the causes of delay gastric emptying is the chronic hypertrophic pyloric gastropathy, unusual disease that can occur in acquired or congenital form. It is characterized by hypertrophy of the antral mucosa, by thickening of the muscular layer, or by hyperplasia of the pylorus. The animals are presented with a history of chronic intermittent vomiting. Treatment is based on surgical correction through techniques such as pyloromyotomy or transverse or Y-U pyloroplasty. Thus, the aim was report three cases of pyloric stenosis by hypertrophy in dogs of the breeds, Fila Brasileiro, English Bull Terrier and American Pitbull Terrier, emphasizing the diagnosis and therapy instituted. Cases: All animals in this study reached the Veterinary Hospital of the Federal University of Mato Grosso with a history of chronic intermittent vomiting. The findings of physical and laboratory examinations in all animals were unspecific, with those important to rule out other causes of vomiting. Contrast radiographic evaluation revealed marked stomach distension and delayed gastric emptying, indicated gastric outflow obstruction. In one case, a video endoscopy was performed. The images reveal hyperemia of the gastric mucosa with small areas of bleeding around the stomach. It was observed intense production of gastric juice and the presence of the same reflux. In the pyloric antrum [...](AU)

AVALIAÇÃO ULTRASSONOGRÁFICA DO ESFÍNCTER PILÓRICO EM CÃES SAUDÁVEIS

O exame ultrassonográfico é amplamente utilizado na Medicina Veterinária para avaliação do trato gastrointestinal. Informações importantes sobre o peristaltismo, morfologia, localização e espessura da parede podem ser fornecidas por meio desse exame. As características ultrassonográficas e medidas de referência para espessura da parede de diversos segmentos do trato gastrointestinal de cães é bem estabelecida na literatura. Entretanto, não foram encontrados trabalhos relacionados ao esfíncter pilórico. Existem várias afecções que podem atingir essa região nos cães, principalmente em raças braquicefálicas. O presente estudo teve como objetivo a avaliação ultrassonográfica do esfíncter pilórico de cães hígidos. Para tanto, foram realizados exames ultrassonográficos de 81 animais, e esses foram divididos em grupos de acordo com as faixas de peso corpóreo. A camada muscular do esfíncter pilórico em plano longitudinal apresentou formato semicircular e espessura maior quando comparada aos segmentos adjacentes. A submucosa da curvatura duodenal cranial foi caracterizada como espessa e pouco definida quando comparada ao restante do duodeno. Os resultados apontaram uma correlação positiva entre a espessura da parede do esfíncter pilórico e o peso corpóreo dos cães avaliados. A média dos valores obtidos para o grupo de peso até 10 Kg foi de 0,52 cm (DP 0,09), > 10 Kg até 20 Kg foi de 0,59 cm (DP 0,15), > 20 Kg até 30 Kg foi de 0,67 cm (DP 0,14) e > 30 Kg foi de 0,73 cm (DP 0,09). Foram observadas diferenças significativas dessas medidas entre os dois grupos de maior peso e o grupo até 10 Kg. Igualmente, o grupo de peso >30 Kg foi significativamente diferente do grupo de peso > 10 Kg até 20 Kg. Os resultados alcançados no presente estudo foram considerados inovadores, podendo ser utilizados como referência para avaliação ultrassonográfica do esfíncter pilórico e auxiliar no diagnóstico de afecções dessa região.

The ultrasound is widely used in Veterinary Medicine to evaluate the gastrointestinal tract. Important information about peristalsis, morphology, topography and wall thickness can be provided by this exam. The ultrasound characteristics and standard measurements for the wall thickness of different segments of the gastrointestinal tract in dogs are well known in the literature. However, no studies related to the pyloric sphincter were found. There are several conditions that can affect this region in dogs, mainly in brachycephalic breeds. The present study aimed at the ultrasonographic evaluation of the pyloric sphincter in healthy dogs. For this purpose, ultrasound examinations of 81 animals were performed, and these were divided into groups according to body weight ranges. The muscular layer of the pyloric sphincter in the longitudinal plane presents a semicircular shape and is thicker when compared to the adjacent segments. The submucosa of the cranial duodenal curvature was characterized as thick and poorly defined when compared to the rest of the duodenum. The results showed a positive correlation between the thickness of the pyloric sphincter wall and the body weight of the evaluated dogs. The average of the values obtained for the weight group up to 10 Kg was 0.52 cm (SD 0.09), > 10 Kg up to 20 Kg was 0.59 cm (SD 0.15), > 20 Kg up to 30 Kg was 0.67 cm (SD 0.14) and > 30 Kg was 0.73 cm (SD 0.09). Differences in these measurements were observed between the two groups with the highest weight and the group weighing up to 10 kg. Equally, the weight group > 30 kg was described differently from the weight group > 10 kg up to 20 kg. The results achieved in the present study were considered innovative and can be used as a reference for ultrasound evaluation of the pyloric sphincter and assisting in the diagnosis of conditions affecting this region.