Utility of drain fluid amylase measurement on the first postoperative day after distal pancreatectomy.

BACKGROUND: Early exclusion of a postoperative pancreatic fistula (POPF) may facilitate earlier drain removal in selected patients after distal pancreatectomy. The purpose of this study was to evaluate the role of first postoperative day drain fluid amylase (DFA1) measurement to predict POPF. METHODS: Patients in whom DFA1 was measured after distal pancreatectomy were identified from a prospectively maintained database over a five-year period. A cut-off value of DFA1 was derived using ROC analysis, which yielded sensitivity and negative predictive value of 100% for excluding POPF. RESULTS: DFA1 was available in 53 of 138 (38%) patients who underwent distal pancreatectomy. 19 of 53 patients (36%) developed a pancreatic fistula (Grade A - 15, Grade B - 3, Grade C - 1). Median DFA1 was significantly higher in those who developed a pancreatic fistula (5473; range 613-28,450) compared those without (802; range 57-2350). p < 0.0001. Using ROC analysis, a DFA1 less than 600 excluded pancreatic fistula with a sensitivity of 100% (AUROC of 0.91; SE = 0.04, p < 0.001). CONCLUSION: First postoperative day drain fluid amylase measurement may have a role in excluding pancreatic fistula after distal pancreatectomy. Such patients may be suitable for earlier drain removal.

Long-term Patient-reported Outcomes After Laparoscopic Fenestration of Symptomatic Liver Cysts.

BACKGROUND: Laparoscopic fenestration is the treatment of choice for symptomatic liver cysts. Despite the benefits of minimally invasive surgery, there is limited data on long-term outcomes after laparoscopic fenestration, in terms of symptom recurrence and quality of life. The purpose of this study was to evaluate long-term patient-reported outcomes and satisfaction following this procedure. METHODS: All patients who underwent laparoscopic liver cyst fenestration in a single center between 2001 and 2012 were identified from a prospectively maintained database. Long-term patient-reported outcomes including symptom relief and quality of life were prospectively evaluated by a structured telephone interview. RESULTS: A total of 98 patients underwent laparoscopic liver cyst fenestration. The median follow-up was 62 months (range, 22 to 173 mo). Follow-up data was available in 48 patients. Four patients developed radiologically confirmed evidence of recurrence with 3 undergoing further surgery. No mortality was reported in the series. Four complications occurred and the median postoperative length of hospital stay was 2 days (range, 1 to 7 d). Thirty-nine patients received immediate symptomatic relief with 98% reporting long-term satisfaction. RESULTS: Laparoscopic liver cyst fenestration is associated with low morbidity and long-term alleviation of symptoms. This should be considered the treatment modality of choice in managing patients with nonparasitic cysts.

Restorative and rejection-associated lymphangiogenesis after renal transplantation: friend or foe?

The review focuses on lymphangiogenesis as a possible contributor to interstitial fibrosis leading to chronic renal transplant injury, which culminates in the loss of 5% transplants annually. The process of lymphatic reconnection after renal transplantation and the mechanisms and mediators of lymphangiogenesis are explored in the context of new specific lymphatic markers. In addition, potentially exciting research avenues are examined, with the specific aim of determining whether new lymphatic formation is beneficial or detrimental to the transplanted kidney.