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1.
Khirurgiia (Mosk) ; (4): 30-36, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352665

RESUMO

OBJECTIVE: To improve the outcomes in patients with severe destructive pancreatitis undergoing minimally invasive surgery. MATERIAL AND METHODS: There were 482 patients with acute destructive pancreatitis for the period from 2007 to 2016. Non-infected acute destructive pancreatitis was diagnosed in 58% (n=280) of patients, infected pancreatic necrosis - in 42% (n=202) of patients. Minimally invasive technologies were used in the treatment of purulent complications of destructive pancreatitis: endoscopic papillotomy, percutaneous puncture of fluid accumulations, ultrasound- and X-ray-assisted drainage of abscesses and retroperitoneal phlegmon. RESULTS: There were 688 drainage surgeries in 92 patients with infected pancreatic necrosis: US-assisted Seldinger drainage - 599 (87%), single-stage drainage - 89 (13%) cases. Percutaneous transfistular retroperitoneal interventions were made in 72 patients (one intervention - 29 patients, redo procedures - 43 patients). Complications associated with minimally invasive procedures developed in 2.7% (19) of cases. Six patients required laparotomy. Mean length of hospital-stay was 36.5 days. Mean rate of restitution of post-necrotic areas was 37.7 days. CONCLUSION: Minimally invasive procedures reduce overall mortality up to 6% in patients with acute pancreatitis and up to 14% in those with destructive forms of inflammation.


Assuntos
Pancreatite/cirurgia , Doença Aguda , Drenagem , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Pancreatite Necrosante Aguda/cirurgia , Resultado do Tratamento
2.
South Med J ; 113(2): 87-92, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32016439

RESUMO

OBJECTIVES: Recent studies have shown a decrease in gallstone-related complications if same-admission cholecystectomy (SAC) is performed in mild gallstone pancreatitis (GSP); however, SAC often is not performed in resource-limited settings such as safety net hospitals. The aims of this study were to evaluate the rate of SAC and compare a composite endpoint of recurrent biliary events in patients undergoing SAC with patients in the delayed cholecystectomy (DC) group. Secondary aims included evaluating the rate of recurrent pancreatitis in patients in the DC group, identifying the predictors for DC and the reasons for not undergoing SAC. METHODS: We reviewed 310 patients admitted in the past 5 years with the diagnosis of acute pancreatitis. Eighty patients were admitted for gallstone pancreatitis; 75% were African American, 18% were white, and the average age was 44 years with a mean body mass index of 30. Forty patients did not receive cholecystectomy before discharge. The DC and SAC groups were similar in body mass index, ethnicity, severity of pancreatitis, and complications. RESULTS: The DC group was significantly more likely to be older and with higher comorbidity indexes compared with the SAC group. Bedside Index of Severity in Acute Pancreatitis scores and revised Atlanta classification definitions were used to define severe acute pancreatitis; 10% (4) of patients had organ failure at 48 hours, whereas 17.5% (7) had a Bedside Index of Severity in Acute Pancreatitis scores ≥3. A total of 14 recurrent biliary events occurred in the DC group (14 of 40), which was 35% compared with 2 of 40 (5%) in the SAC group (P < 0.001). Of the 9 patients who developed recurrent pancreatitis, 8 were in the DC group (8 of 40, 20%, P = 0.02). Of the 40 patients in the DC group, only 14 patients eventually received a cholecystectomy documented in our hospital, with median-length postdischarge follow-up of approximately 6.5 months. On regression analysis, a Charlson Comorbidity Index >2 was the only significant predictor of DC. The most common reason for DC was no surgical consultation during the inpatient stay (22%). CONCLUSIONS: Our findings support existing evidence that DC is associated with a significantly increased risk of recurrent biliary events and pancreatitis. Furthermore, we report a 56% adherence to the current guidelines for SAC and report that the most common reason for not undergoing SAC was the absence of surgical consultation. We conclude that ensuring SAC in eligible patients should be a priority for safety net hospitals because it may help decrease hospital costs in the long term, and active efforts should be made to identify patients who may be less likely to receive SAC.


Assuntos
Colecistectomia/estatística & dados numéricos , Cálculos Biliares/cirurgia , Pancreatite/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Fatores de Tempo , Doença Aguda , Adulto , Feminino , Cálculos Biliares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Provedores de Redes de Segurança
3.
Khirurgiia (Mosk) ; (1): 33-39, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994497

RESUMO

OBJECTIVE: To evaluate the results of stenting of the main pancreatic duct for acute post-manipulation pancreatitis. MATERIAL AND METHODS: There were 946 transpapillary interventions within 5-year period. Various risk factors of this complication and the role of stenting of the main pancreatic duct for prevention of acute post-manipulation pancreatitis were analyzed for the same period. Complication was predicted only in some cases. There were 10 patients with unpredicted acute pancreatitis for this period. In all cases, an attempt of stenting of the main pancreatic duct was made in the first hours after development of complication. Stenting was successful in 7 cases. Technical success of operation was 70%. Stenting was followed by clinical improvement and pain relief. RESULTS: The course of acute post-manipulation pancreatitis is milder in patients who underwent pancreatic stenting. There were no cases of purulent-necrotic complications in these patients (n=7). At the same time, 2 cases of pancreatic necrosis were observed in the control group. One patient died among those who did not undergo stenting of the pancreatic duct. CONCLUSION: Stenting of the main pancreatic duct is effective in patients with acute post-manipulation pancreatitis. The course of acute post-manipulation pancreatitis is milder in patients who underwent pancreatic stenting. Significant clinical improvement is observed the next day after stenting. Stenting of the pancreatic duct should be carefully considered early after development of complication.


Assuntos
Ductos Pancreáticos/cirurgia , Pancreatite/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Pancreatite/etiologia , Implantação de Prótese , Stents , Fatores de Tempo
4.
Clin Biochem ; 77: 54-56, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899279

RESUMO

BACKGROUND: Despite widespread recommendations to favor lipase over amylase in the diagnosis and management of acute pancreatitis, many routine hospital laboratories still offer amylase testing. This study sought to evaluate and compare ordering patterns of amylase and lipase in patients with acute pancreatitis. METHODS: We analyzed 438 patients with acute pancreatitis admitted to our hospital. Data collection included pancreatitis etiology and management as well as biochemical profiles of amylase and lipase. We compared serial ordering patterns, degree of biomarker elevation, and normalization kinetics. RESULTS: All patients had at least one lipase ordered during their admission, and only 51 patients (12%) had at least one amylase ordered. On average, lipase was elevated 5 times higher above its respective upper reference limit than amylase at admission. Pancreatitis etiology was skewed toward gallstones in the amylase group as compared to the lipase only group (69% vs. 43%), and surgical patients (laparoscopic cholecystectomy) were more likely to have amylase ordered and/or trended. CONCLUSIONS: Amylase measurement was not necessary in the diagnosis and management of 88% of patients with acute pancreatitis. Of patients for whom amylase was ordered, it was common for these patients to be those referred to surgical procedures, possibly because amylase normalization may be documented faster than that of lipase.


Assuntos
Amilases/metabolismo , Colecistectomia Laparoscópica/métodos , Pancreatite/diagnóstico , Adulto , Biomarcadores/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/enzimologia , Pancreatite/metabolismo , Pancreatite/cirurgia
5.
Rev Med Chil ; 147(8): 1078-1081, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859975

RESUMO

Acute pancreatitis during pregnancy is uncommon and usually associated with gallstones. However other etiologies must be considered. We report a 24 years old woman with a 32 weeks pregnancy consulting for abdominal pain, nausea and vomiting. She had elevated lipase and amylase levels, a corrected serum calcium of 13.1 mg/dl and a serum phosphate of 1.6 mg/dl. A magnetic resonance colangiopancreatography showed an enlarged pancreas with inflammatory changes and a normal Wirsung duct. A parathyroid nodule was found on cervical ultrasonography. The patient was treated initially with cinacalcet with partial response. A parathyroidectomy was performed at 39 weeks of pregnancy with a good maternal and fetal evolution.


Assuntos
Hipercalcemia/complicações , Pancreatite/etiologia , Complicações na Gravidez/etiologia , Dor Abdominal/etiologia , Adenoma/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética/métodos , Feminino , Humanos , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Paratireoidectomia/métodos , Gravidez , Complicações na Gravidez/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Khirurgiia (Mosk) ; (11): 37-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714528

RESUMO

OBJECTIVE: To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION: Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colelitíase/cirurgia , Pancreatite/cirurgia , Doença Aguda , Colelitíase/diagnóstico , Colelitíase/etiologia , Seguimentos , Humanos , Pancreatite/etiologia
7.
Medicine (Baltimore) ; 98(40): e17429, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577759

RESUMO

BACKGROUND: The optimal timing of laparoscopic cholecystectomy (LC) in patients with mild acute gallstone pancreatitis (MAGP) is controversial. The aim of this study was to systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with MAGP. METHODS: A strict search was conducted of the electronic databases, including PubMed, MEDLINE Embase, the ISI Web of Science, and Cochrane Library for all relevant English literature and RevMan5.3 software for statistical analysis was used. RESULTS: A total of 19 studies comprising 2639 patients were included. There was no significant difference in intraoperative complications [risk ratio (RR) = 1.46; 95% confidence interval (CI) = 0.88-2.41; P = .14)], postoperative complications (RR = 0.81; 95% CI = 0.58-1.14; P = .23), rate of conversion to open cholecystectomy (RR = 1.00; 95% CI = 0.75-1.33; P = .99), operative time (MD = 1.60; 95% CI = -1.36-4.56; P = .29), and rate of readmission (RR = 0.63; 95% CI = 0.19-2.10; P = .45) between the ELC and DLC groups. However, the ELC group was significantly correlated with lower length of hospital stay (MD = -2.01; 95% CI = -3.15 to -0.87; P = .0006), fewer gallstone-related events rates (RR = 0.17; 95% CI = 0.07-0.44; P = .0003), and lower endoscopic retrograde cholangiopancreatography (ERCP) usage (RR = 0.83; 95% CI = 0.71-0.97; P = .02) compared with the DLC group. CONCLUSION: Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares/cirurgia , Pancreatite/cirurgia , Tempo para o Tratamento , Cálculos Biliares/complicações , Humanos , Pancreatite/etiologia
8.
World J Gastroenterol ; 25(39): 6006-6015, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31660036

RESUMO

BACKGROUND: In pancreatic cancer, acute pancreatitis (AP) is a serious morbidity, but its negative effect on long-term outcomes remains to be elucidated. AIM: To investigate the effects of AP on the tumor recurrence pattern of pancreatic ductal adenocarcinoma (PDAC) and tumor-specific survival. METHODS: The medical records of 219 patients with curative pancreatectomy for pancreatic cancer at the Pancreatic Surgery Center of West China Hospital from July 2012 to December 2016 were analyzed retrospectively. The severity of acute pancreatitis was classified according to the Atlanta classification of AP. The patient demographics and tumor characteristics were assessed. Early recurrence was defined as a relapse within 12 mo after surgery. Overall and disease-free survival and recurrence patterns were analyzed. Mild acute pancreatitis was excluded because its negative effects can be negligible. RESULTS: Early recurrence in AP group was significantly higher than in non-AP group (71.4% vs 41.2%; P = 0.009). Multivariate analysis of postoperative early recurrence showed that moderate or severe AP was an independent risk factor for an early recurrence [odds ratio (OR): 4.13; 95% confidence interval (CI): 1.41-12.10; P = 0.01]. The median time to recurrence was shorter in patients with AP than in those without (8.4 vs 12.8 mo; P = 0.003). Multivariate analysis identified AP as an independent prognostic factor for overall survival [relative risk (RR): 2.35; 95%CI: 1.45-3.83] and disease-free survival (RR: 2.24; 95%CI: 1.31-3.85) in patients with PDAC. CONCLUSION: Patients with moderate or severe acute pancreatitis developed recurrences earlier than those without. Moderate or severe AP is associated with shorter overall and disease-free survival of patients with PDAC.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreatite/epidemiologia , Adulto , Idoso , Carcinoma Ductal Pancreático/complicações , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/mortalidade , China , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/mortalidade , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de Tempo
10.
Khirurgiia (Mosk) ; (9): 13-17, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532161

RESUMO

OBJECTIVE: To study the effect of pancreatic duct stenting on the results of treatment of acute pancreatitis. MATERIAL AND METHODS: Analysis included 99 patients with acute pancreatitis. Endoscopic stentingwas appliedin the study group, conventional approach - in the control group. RESULTS: Pancreatic duct stenting at theearly stages ofacute pancreatitis results decreased level of enzyme toxemia and manifestations of systemic inflammatory response. CONCLUSION: Stenting interrupts course of pathological process and minimizes the possibility of transition of aseptic to infected pancreatic necrosis. Therefore, reduced early mortalityis observed.


Assuntos
Ductos Pancreáticos/cirurgia , Pancreatite/cirurgia , Stents , Doença Aguda , Endoscopia do Sistema Digestório , Humanos , Implantação de Prótese
11.
Zhonghua Wai Ke Za Zhi ; 57(9): 654-659, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31474056

RESUMO

Objective: To analyze the risk factors for biochemical leak progressing to grade B pancreatic fistula after pancreaticoduodenectomy(PD) early. Methods: Retrospective analysis was conducted in the whole clinical data of 190 patients who had incurred biochemical leak from November 2014 to April 2017 at the First Hospital of China Medical University.There were 112 males and 78 females, aging of (73±6) years(range:22 to 77 years).And all the potential factors for progressing from biochemical leak to grade B were analyzed with univariate and logistic regression multivariate model. These statistically significant preoperative indicators which enabled the plotting of the receiver operation characteristic(ROC) curves were selected for plotting the ROC curves, calculating the area under the curve(AUC) and evaluating the forecast values. With pertinence to indicators with the forecast values above the medium level, the maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators. Results: Among the 190 cases of PD patients, there were 81 cases had incurred biochemical leak including 36 cases with no progression, 41 cases progressing to grade B and 4 cases progressing from grade B to grade C.Univariate analysis showed CT value of pancreatic body, acute pancreatitis preoperatively, and the platelet(PLT), prealbumin, ALT on postoperative 3-4 days were risk factors for progressing from biochemical leak to grade B. Multivariate analysis showed CT value, acute pancreatitis preoperatively, and the PLT on postoperative 3-4 days were independent risk factors. Postoperatively patients with biochemical leak got acute pancreatitis before surgery were more likely to progress to grade B as well as those with the lower CT value before surgery or the lower PLT at 3-4 days after surgery. The AUC of CT value was 0.734. Using 39.8 HU as CT value, the sensitivity, specificity and Youden index were 73.2%, 75.0% and 0.482, with the highest performance prediction. Conclusion: The analysis of CT value of pancreatic body for standardized judgment of pancreas texture, the rational treatments of acute pancreatitis preoperatively and appropriate administration of patients with platelet-related drugs during perioperative period can respectively forecast and prevent progressing from biochemical leak to grade B.


Assuntos
Fístula Anastomótica/etiologia , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Doença Aguda , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatite/complicações , Pancreatite/cirurgia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
BMC Gastroenterol ; 19(1): 141, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395017

RESUMO

BACKGROUND: Abdominal compartment syndrome (ACS) is associated with mortality in patients with critical illness such as severe acute pancreatitis, but it remains unclear whether decompressive laparotomy for ACS can improve the prognosis of patients. CASE PRESENTATION: A woman in her 60s visited our hospital because of upper abdominal pain. On the basis of her laboratory data and abdominal contrast-enhanced computed tomography findings, acute gallstone pancreatitis was diagnosed. She underwent endoscopic sphincterotomy for the removal of the common bile duct stone. Then, a drainage tube was placed in the bile duct. However, on the 5th hospital day, her intra-abdominal pressure increased to 22 mmHg and renal dysfunction was observed, which led to the diagnosis of ACS. As intensive medical treatments did not improve her ACS, she underwent decompressive laparotomy on the 9th hospital day. Postoperatively, her laboratory data and intravesical pressure improved, and she was discharged from the hospital after abdominal closure, continuous drainage, and antibiotic therapy. CONCLUSION: As the effectiveness of decompressive laparotomy for ACS has not been established, this treatment indication remains controversial. Decompressive laparotomy is considered useful for the management of ACS, if it is performed at an appropriate time, as in the present case.


Assuntos
Descompressão Cirúrgica/métodos , Hipertensão Intra-Abdominal/cirurgia , Laparotomia/métodos , Pancreatite/cirurgia , Humanos , Hipertensão Intra-Abdominal/diagnóstico por imagem , Hipertensão Intra-Abdominal/etiologia , Pancreatite/diagnóstico por imagem
14.
Internist (Berl) ; 60(9): 982-986, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31317221

RESUMO

Spontaneous splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 60-year-old man with acute pancreatitis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for 2 days. He was diagnosed with acute pancreatitis of alcoholic etiology. The patient was admitted to the hospital for two recurrent episodes in the last 4 months of acute pancreatitis of alcoholic etiology. Magnetic resonance imaging of the abdomen revealed a suspicious area of necrosis. Seventy-two hours after admission, the patient had significant improvement in symptoms and the inflammation markers rapidly decreased. However, he showed clinical worsening on the seventh day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was performed with resection of the pancreatic tail.


Assuntos
Dor Abdominal/etiologia , Pancreatite/complicações , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Dor Abdominal/cirurgia , Doença Aguda , Doença Crônica , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/cirurgia , Ruptura Espontânea , Esplenectomia , Ruptura Esplênica/cirurgia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(28): e16435, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305468

RESUMO

RATIONALE: Mucinous cystic neoplasms (MCNs) are pancreatic mucin-producing cystic lesions with a distinctive ovarian-type stroma. The diagnosis is generally easy in typical cases; however, differential diagnosis is difficult in others such as in the case we report herein. PATIENT CONCERNS: A 27-year-old woman with sudden onset of epigastric pain was referred to our hospital for suspected acute pancreatitis. Contrast-enhanced computed tomography revealed a 25-mm cystic lesion in the pancreas and a low density area with delayed enhancement at the right upper side of the cystic lesion. DIAGNOSES: During its clinical course, the cystic lesion underwent various morphological changes. Eventually, it presented typical findings of MCNs, and could be accurately diagnosed. INTERVENTIONS: Laparoscopic distal pancreatectomy was performed on the patient by preserving the spleen. OUTCOMES: The patient revealed no symptoms till 1 year after the operation. LESSONS: This case of MCN with intriguing short-term morphological changes was associated with recurrent pancreatitis. A combination of imaging modalities is essential for accurate diagnosis of MCNs, and follow-up with serial imaging might be useful for certain unusual lesions.


Assuntos
Adenocarcinoma Mucinoso/patologia , Pâncreas/patologia , Cisto Pancreático/patologia , Neoplasias Pancreáticas/patologia , Pancreatite/patologia , Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Adulto , Progressão da Doença , Feminino , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Cisto Pancreático/complicações , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Pancreatite/complicações , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Recidiva
16.
Br J Surg ; 106(11): 1442-1451, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31268184

RESUMO

BACKGROUND: Gallstones account for 30-50 per cent of all presentations of acute pancreatitis. While the management of acute pancreatitis is usually supportive, definitive treatment of gallstone pancreatitis is cholecystectomy. Guidelines from the British Society of Gastroenterology suggest definitive treatment on index admission or within 2 weeks of discharge, whereas joint recommendations from the International Association of Pancreatology and the American Pancreatic Association recommend definitive treatment on index admission. Evidence suggests that uptake of these guidelines is low. METHODS: Embase, MEDLINE and Cochrane databases were searched for RCTs investigating early versus delayed cholecystectomy in patients with a confirmed diagnosis of mild gallstone pancreatitis. The pooled synthesis was undertaken using a random-effects meta-analysis of the primary outcome of recurrent biliary complications causing hospital readmission. Secondary outcomes included intraoperative and postoperative complications, and total length of hospital stay (LOS). All analyses were performed using RevMan5 software. RESULTS: Five RCTs were identified, which included 629 patients (318 in the early cholecystectomy (EC) group and 311 in the delayed cholecystectomy (DC) group). Recurrent biliary events that required readmission were reduced in patients undergoing EC compared with the number in patients having DC (odds ratio (OR) 0·17, 95 per cent c.i. 0·09 to 0·33). There was no difference in the rate of intraoperative (OR 0·58, 0·17 to 1·92) or postoperative (OR 0·78, 0·38 to 1·62) complications. CONCLUSION: EC following mild gallstone pancreatitis does not increase the risk of intraoperative or postoperative complications, but reduces the readmission rate for recurrent biliary complications.


Assuntos
Colecistectomia/estatística & dados numéricos , Cálculos Biliares/cirurgia , Pancreatite/cirurgia , Adulto , Idoso , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Reoperação/estatística & dados numéricos , Tempo para o Tratamento
19.
Pancreatology ; 19(5): 638-645, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31204259

RESUMO

BACKGROUND: /Objectives: Evaluation of the local and systemic effects of aging on the severity of acute pancreatitis (AP) in an experimental rat model in elderly animals. METHODS: AP was induced in Wistar rats by intraductal 2.5% taurocholate injection and divided into two groups: Young (3 month old) and Aged (18 month old). Two and 24 h after AP induction blood samples were collected for determinations of amylase, AST, ALT, urea, creatinine, glucose, and of plasma I-FABP. TNF-α and IL-6 levels were determined in serum and ascitic fluid. Liver mitochondrial function and malondialdehyde (MDA) contents, pancreas histological analysis, and pulmonar myeloperoxidade (MPO) activity were performed. Bacterial translocation was evaluated by bacterial cultures of pancreas. RESULTS: A significant increase in serum amylase, AST, ALT, urea, creatinine, glucose, I-FABP, and IL-6 levels, and a reduction in serum and ascitic fluid TNF-α levels were observed in the aged group compared to the young group. Liver mitochondrial dysfunction, MDA contents, and pulmonary MPO activity were increased in the Aged AP group compared to the Young AP group. Positive bacterial cultures obtained from pancreas tissue in aged group were significantly increased compared to the young group. Acinar necrosis was also increased in aged AP group when compared to young AP group. CONCLUSION: Aging worsens the course of acute pancreatitis evidenced by increased local and systemic lesions and increased bacterial translocation.


Assuntos
Envelhecimento/patologia , Pancreatite/patologia , Doença Aguda , Animais , Citocinas/sangue , Proteínas de Ligação a Ácido Graxo/metabolismo , /fisiopatologia , Peroxidação de Lipídeos , Masculino , Mitocôndrias Hepáticas/metabolismo , Necrose , Oxirredução , Pancreatite/cirurgia , Peroxidase/metabolismo , Fosforilação , Ratos , Ratos Wistar
20.
Ann R Coll Surg Engl ; 101(6): 422-427, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155890

RESUMO

INTRODUCTION: Despite an increasing emphasis on data-driven quality improvement, few validated quality indicators for emergency surgical services have been published. The aims of this study therefore were: 1) to investigate whether the acute cholecystectomy rate is a valid process indicator; and 2) to use this rate to examine variation in the provision of acute cholecystectomy in England. MATERIALS AND METHODS: The Surgical Workload and Outcomes Research Database (SWORD), derived from the Hospital Episode Statistics database, was interrogated for the 2012-2017 financial years. All adult patients admitted with acute biliary pancreatitis, cholecystitis or biliary colic to hospitals in England were included and the acute cholecystectomy rate in each one examined. RESULTS: A total of 328,789 patients were included, of whom 42,642 (12.9%) underwent an acute cholecystectomy. The acute cholecystectomy rate varied significantly between hospitals, with the overall rate ranging from 1.2% to 36.5%. This variation was consistent across all disease groupings and time periods, and was independent of the annual number of procedures performed by each NHS trust. In 41 (29.9%) trusts, fewer than one in ten patients with acute gallbladder disease underwent cholecystectomy within two weeks. CONCLUSIONS: The acute cholecystectomy rate is easily measurable using routine administrative datasets, modifiable by local services and has a strong evidence base linking it to patient outcomes. We therefore advocate that it is an ideal process indicator that should be used in quality monitoring and improvement. Using it, we identified significant variation in the quality of care for acute biliary disease in England.


Assuntos
Colecistectomia/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Doença Aguda , Doenças Biliares/cirurgia , Colecistectomia/normas , Colecistite Aguda/cirurgia , Cólica/cirurgia , Bases de Dados Factuais , Emergências , Inglaterra , Humanos , Pancreatite/cirurgia , Reprodutibilidade dos Testes
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