ABSTRACT
Objective: To evaluate the utility of percutaneous cholecystostomy tube in patients with acute calculus cholecystitis, who are considered unfit for immediate surgery. Study Design: Observational study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2014
Methodology: All adult patients who underwent percutaneous cholecystostomy tube placement for acute calculous cholecystitis were included. These patients were divided into two groups for further analysis. Group-I consisted those who had interval cholecystectomy after tube placement and Group-II were those who had no further treatment. Recurrence of symptoms, infections and operation related complications were noted
Results: Sixty-five patients met the inclusion criteria. Mean age was 58.5 years. Forty-four patients [67.7%] were males. Forty-three patients underwent interval cholecystectomy [Group-I] and 22 did not [Group-II]. Mean operative time was 134.9 +57.8 minutes. Five [11.6%] patients were converted to open cholecystectomy, two [4.6%] developed CBD injury, and seven [16.2%] developed surgical site infection. In Group-II, three patients [13.6%] developed recurrence of symptoms and 19 [86.4%] remained symptom-free. Catheter related problems occurred in four [18%] patients. Mean follow-up was 19 +8 months
Conclusion: Percutaneous cholecystostomy is a good alternative for patients unfit to undergo immediate surgery. Recurrence of symptoms after tube removal are in a low range; therefore, it can be considered a definitive management for high risk patients. Laparoscopic cholecystectomy after tube placement becomes technically challenging
ABSTRACT
Option for borderline resectable pancreatic cancer is pancreaticoduodenectomy [PD] with vascular resection and reconstruction. We would like to share our experience of vascular reconstruction. First patient was a 51-year male with pancreatic head carcinoma, involving posterior wall of portal vein [PV] and replacing right hepatic artery [RHA]. Along with PD, he underwent PV and RHA resection and reconstruction. Second case was a 33-year female who had distal pancreatic cyst and PV-splenic vein junction involved by tumor. Distal pancreatectomy+splenectomy and PV primary resection-reconstruction was done. Third case was a 72-year male with pancreatic neck adenocarcinoma involving PV-SMV junction. Subtotal pancreatecomy+splenectomy was done along with PV-reconstruction via splenic vein patch graft. Fourth case was a 77-year male with cystic pancreatic head mass involving PV. PD with resection and reconstruction of portal vein was done. Fifth case was a 35-year female with peri-ampullary tumor replacing RHA, coursing through the pancreatic parenchyma. So RHA was resected and reconstructed in an end-to-end fashion. Vascular resection-reconstruction can be done in borderline pancreatic cancer patients, and a considerable survival benefit can be achieved