Multivariate analysis of perioperative risk factors of pancreatic remnant leakage after pancreaticoduodenectomy

This study was carried on 24 patients suffering from periampullary carcinoma. All the patients were admitted to Department of Surgery, Main Alexandria University Hospital, and underwent the original Whipple's operation. After Whipple's operation, anastomosis of the pancreatic stump was done by means of pancreaticojejunostomy dunking method, pancreatieo-jejunostomy mueosa to mucosa, pancreatico-gastrostomy implantation method and pancreatico-gastrostomy rnucosa to mucosa method. Each method was done in 6 patients. Leakage occurred in 5 patients [20.8%], 3 [12.5%] of them had leaked after pancreaticojejunostomy dunking method, and the other 2 [8.3%] leaked after panereatieogastrostomy implantation method. After pancreaticojejunostomy dunking method 2 leaking patients died within 30 days of surgery, and the other patient resolved with conservative management. The leaked patients after pancreaticogastrostomy implantation method resolved with conservative management. The incidence of leakage increased with older age, lengthened operative time, increased blood replacement, soft pancreatic texture at the site of cutting and preoperative biliary drainage

Study of gastric malignant neoplasms in the surgical gastroenterology unit in the Main Alexandria University Hospital

The present work included data of 42 patients with gastric malignant neoplasms that were admitted to the gastroenterology surgical unit of the main Alexandria university hospital in the period from September 2002 through December 2004 [28 months]. The highest incidence was in the age group above 50 years [61.9%]. The male to female ratio was 1.5:1. the commonest symptom was loss of weight in 23 patients [54.76%]. The main site affected was the pyloric antrum in 22patients [52.38%]. Other sites were the body [67%], cardia [14.29%], and fundus [9.52%]. Three tumors were diffuse [7.14%]. Adenocareinoma was present in 32 patients [76, 19%]; 14 patients had a poorly differentiated tumor, Il patients [34.38%] had moderately differentiated tumor, and in 7 patients [21.88%] the tumor was well-differentiated. Other microscopic types included mucoid carcinoma [11.9%], Non-Hodgkin's lymphoma [7.14%], signet ring carcinoma [2.38%] and squamous cell carcinoma [2.38%]. The diagnostic procedure included upper GIT endoscopy with biopsy taking that was diagnostic in 100% of the study group. Barium meal was done for 34 patients and was diagnostic in 29 [[85.29%]. Conventional Ultrasonography was carried out for 32 patients and was diagnostic in 18 [56.25%]. CT was done for all patients and was of diagnostic value in 92.86% [39 patients]. The major lines of treatment were gastreetomy either total or subtotal [80.95%], while palliative resection was done in three patients [7.14%]. Palliative feeding jejunostomy was done in 2 patients [4.76%]. and there was no surgical interference in one advanced ease only [2.38%]