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Biliary leakage following pancreaticoduodenectomy:Prevalence,risk factors and management

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 67-72页

作者： ayman el nakeeb mohamed el Sorogy Hosam Hamed Rami Said mohamad elrefai Helmy Ezzat Waleed Askar Ahmed m elsabbagh Gastroenterology Surgical Center Mansoura University

Background: Few studies investigated biliary leakage after pancreaticoduodenectomy(PD) especially when compared to postoperative pancreatic fistula(POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. methods: We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, mansoura University, Egypt. According to occurrence of postoperative biliary leakage, patients were divided into two groups. Group(1) included patients who developed biliary leakage and group(2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed. Results: The study included 555 patients. Forty-four patients(7.9%) developed biliary leakage. Ten patients(1.8%) had concomitant POPF. multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography(ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients(90.9%). Only 4 patients(9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group(6.8% vs 3.9%, P = 0.05). Conclusions: Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. Howeve

关键词： Pancreatic head carcinoma Pancreaticodudenetomy Postoperative pancreatic fistula Biliary leakage

Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: A retrospective study of 5-year survivors

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Hepatobiliary & Pancreatic Diseases International 2018年第5期17卷 443-449页

作者： ayman el nakeeb mohamed el Sorogy Helmy Ezzat Rami Said mohamed el Dosoky mohamed Abd el Gawad Ahmed m elsabagh Ehab el Hanafy Gastroenterology Surgical Center Mansoura University

Background: Pancreaticoduodenectomy(PD) is the standard curative treatment for periampullary tumors. The aim of this study is to report the incidence and predictors of long-term survival( ≥ 5 years) after PD. methods: This study included patients who underwent PD for pathologically proven periampullary adenocarcinomas. Patients were divided into 2 groups: group(I) patients who survived less than 5 years and group(II) patients who survived ≥ 5 years. Results: There were 47(20.6%) long-term survivors( ≥ 5 years) among 228 patients underwent PD for periampullary adenocarcinoma. Patients with ampullary adenocarcinoma represented 31(66.0%) of the long-term survivors. Primary analysis showed that favourable factors for long-term survival include age m CEA mL, serum CA 19-9 mL, non-cirrhotic liver, tumor size m, site of primary tumor, postoperative pancreatic fistula, R0 resection, postoperative chemotherapy, and no recurrence. multivariate analysis demonstrated that CA 19-9 mL [OR(95% CI) = 1.712(1.24 8–2.34 8), P = 0.001], smaller tumor size [OR(95% CI) = 1.335(1.032–1.726), P = 0.028] and R0 resection [OR(95% CI) = 3.098(2.095–4.582), P mpullary adenocarcinoma, for which the median survival was 54 months and 5-year survival rate was 39.0%, and the poorest was pancreatic head adenocarcinoma, for which the median survival was 27 months and 5-year survival rate was 7%. Conclusions: The majority of long-term survivors after PD for periampullary adenocarcinoma are patients with ampullary tumor. CA 19-9 mL, smaller tumor size, and R0 resection were found to be independent factors for long-term survival ≥ 5 years.

关键词： Pancreatic carcinoma Pancreatic head carcinoma Pancreaticodudenectomy Long-term survival

Clinicopathological features and surgical outcome of patients with fibrolamellar hepatocellular carcinoma(experience with 22 patients over a 15-year period)

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World Journal of Gastrointestinal Surgery 2017年第2期9卷 61-67页

作者： mohamed Abdel Wahab Ehab el Hanafy ayman el nakeeb mahmoud Abdelwahab Ali Gastroenterology Surgical Center Mansoura UniversityMansoura 35516Egypt

AIm To evaluate the clinicopathological features and the surgical outcomes of patients with fibrolamellar hepato-cellular carcinoma(FL-HCC)over a 15-year period. mETHODS This is a retrospective study including 22 patients with a pathologic diagnosis of FL-HCC who underwent hepatectomy over a 15-year period. Tumor characteristics,survival and recurrence were evaluated. RESULTS There were 11 male and 11 female with a median age of 29 years(range from 21 to 58 years). Two(9%)patients had hepatitis C viral infection and only 2(9%)patients had alpha-fetoprotein level > 200 ng/m L. The median size of the tumors was 12 cm(range from 5-20 cm). Vascular invasion was detected in 5(23%)patients. Four(18%)patients had lymph node metastases. The median follow up period was 42 mo and the 5-year survival was 65%. Five(23%)patients had a recurrent disease,4 of them had a second surgery with 36 mo median time interval. Vascular invasion is the only significant negative prognostic factor CONCLUSION FL-HCC has a favorable prognosis than common HCC and should be suspected in young patients with non cirrhotic liver. Aggressive surgical resection should be done for all patients. Repeated hepatectomy should be considered for these patients as it has a relatively indolent course.

关键词： Fibrolamellar hepatocellular carcinoma Common hepatocellular carcinoma Recurrence after resection fibrolamellar hepatocellular carcinoma Pathology of fibrolamellar hepatocellular carcinoma Survivalefter resection fibrolamellar hepatocellular carcinoma

Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 528-536页

作者： ayman el nakeeb Ahmad m Sultan Ehab Atef Ali Salem mostaffa Abu Zeid Ahmed Abu el Eneen Gamal el Ebidy mohamed Abdel Wahab Gastroenterology Surgical Center Mansoura UniversityMansoura 35516 Egypt

BACKGROUND: Pancreatic reconstruction following pancreaticoduodenectomy(PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula(POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of *** study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump. mETHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group(absent risk factor), moderate-risk group(presence of one risk factor) and high-risk group(presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BmI >25 kg/m~2, cirrhotic liver, soft pancreas, pancreatic duct diameter mm, and pancreatic duct location from posterior edge mm are risk variables for development of postoperative complications. POPF developed in 128(14.3%) patients. Delayed gastric emptying occurred in 164(18.4%) patients, biliary leakage developed in 65(7.3%) and pancreatitis presented in 20(2.2%). POPF in low-, moderate-and high-risk groups were 26(8.3%), 65(15.7%) and 37(22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pancreaticogastrostomy(PG) in high-risk group, while pancreaticojejunostomy(PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in l

关键词： periampullary tumor pancreaticogastrostomy pancreaticojejunostomy pancreaticoduodenectomy postoperative pancreatic fistula

Impact of referral pattern and timing of repair on surgical outcome after reconstruction of post-cholecystectomy bile duct injury:A multicenter study

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 53-60页

作者： ayman el nakeeb Ahmad Sultan Helmy Ezzat mohamed Attia mohamed Abd elWahab Taha Kayed ayman Hassanen Ahmad Almalki Ahmed Alqarni mohammed m mohammed Gastrointestinal Surgical Center Mansoura UniversityMansouraEgypt minia University Hospital MiniaEgypt Aseer Central Hospital Aseer regionSaudi Arabia

Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical *** guideline exists to guide the timing of repair,while few studies compare early versus late repair *** study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of ***:We retrospectively analyzed 412 patients with BDI from march 2015 to January *** patients were divided into three groups based on the time of BDI *** 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and *** outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group *** BDI and level E4 BDI were independent factors of unfavorable ***:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy *** ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.

关键词： Bile duct injury Hepaticojejunostomy Anastomotic stricture Biloma Biliary peritonitis

Outcomes of pancreaticoduodenectomy in elderly patients

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Hepatobiliary & Pancreatic Diseases International 2016年第4期15卷 419-427页

作者： ayman el nakeeb Ehab Atef Ehab el Hanafy Ali Salem Waleed Askar Helmy Ezzat Ahmed Shehta mohamed Abdel Wahab Gastroenterology Surgical Center Mansoura University

BACKGROUND： Although the mortality and morbidity of pancreaticoduodenectomy（PD） have improved significantly over the past years, the concerns for elderly patients undergoing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly patients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly ***： We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age： group I（patients aged 〈60 years）, group II（those aged 60 to 69 years） and group III（those aged ≥70 years）. The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival ***： A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579（69.9%） patients in group I, 201（24.3%） in group II, and 48（5.8%） in group III. The overall incidence of complications was higher in elderly patients（25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006）. There were more patients complicated with delayed gastric emptying in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital ***： PD can be performed safely in selected elderly patients. Advanced age alone should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of associated comorbidities.

关键词： pancreaticoduodenectomy elderly pancreatic fistula delayed gastric emptying

Efficacy of octreotide in the prevention of complications after pancreaticoduodenectomy in patients with soft pancreas and non-dilated pancreatic duct: A prospective randomized trial

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 59-63页

作者： ayman el nakeeb Ahmed el Gawalby mahmoud A.Ali Ahmed Shehta Hosam Hamed mohamed el Refea Ahmed moneer Ahmed Abd el Rafee Gastroenterology Surgical Center Mansoura University

Background: The efficacy of octreotide to prevent postoperative pancreatic fistula(POPF) of pancreaticoduodenectomy(PD) is still controversial. This study aimed to evaluate the effect of postoperative use of octreotide on the outcomes after ***: This is a prospective randomized controlled trial for postoperative use of octreotide in patients undergoing PD. Patients with soft pancreas and pancreatic duct mm were randomized to 2 *** I did not receive postoperative octreotide. Group II received postoperative octreotide. The primary end of the study is to compare the rate of ***: A total of 104 patients were included in the study and were divided into two randomized *** were no significant difference in overall complications and its severity. POPF occurred in 11 patients(21.2%) in group I and 10(19.2%) in group II, without statistical significance(P = 0.807). Also, there was no significant differences between both groups regarding the incidence of biliary leakage(P = 0.083), delayed gastric emptying(P = 0.472), and early postoperative mortality(P = 0.727).Conclusions: Octreotide did not reduce postoperative morbidities, reoperation and mortality rate. Also, it did not affect the incidence of POPF and its clinically relevant variants.

关键词： Pancreaticoduodenectomy Postoperative pancreatic fistula Octreotide Periampullary tumor

Intraoperative endoscopic retrograde cholangiopancreatography: A useful tool in the hands of the hepatobiliary surgeon

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World Journal of Gastroenterology 2015年第2期21卷 609-615页

作者： ayman el nakeeb Ahmad m Sultan Emad Hamdy Ehab el Hanafy Ehab Atef Tarek Salah Ahmed A el Geidie Tharwat Kandil mohamed el Shobari Gamal el Ebidy Gastroenterology surgical center Mansoura UniversityDaqahlia 35516Egypt

AIm: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography(ERCP) combined with laparoscopic cholecystectomy(LC) forpatients with gall bladder stones(GS) and common bile duct stones(CBDS).mETHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram(TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven ***: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases(84.2%) where removal of stones were successful; passed stones in 6 cases(7.9%); short lower end stricture with small stones present in two cases(2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case(1.3%) which was treated by open hepaticojejunostomy; and one case(1.3%) was proved to be ampullary carcinoma and whipple's operation was scheduled. CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.

关键词： Obstructive jaundice Endoscopic retrograde cholang

Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy

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World Journal of Gastroenterology 2013年第41期19卷 7129-7137页

作者： ayman el nakeeb Ahmad m Sultan Tarek Salah mohamed el Hemaly Emad Hamdy Ali Salem Ahmed moneer Rami Said Ahmed Abueleneen mostafa Abu Zeid Talaat Abdallah mohamed Abdel Wahab Gastroenterology surgical center Mansoura UniversityMansoura 35516Egypt

AIm:To elucidate surgical outcomes of pancreaticoduodenectomy(PD)in patients with liver ***:We studied retrospectively all patients who underwent PD in our centre between January 2002and December *** A comprised patients with cirrhotic livers,and Group B comprised patients with non-cirrhotic *** cirrhotic patients had ChildPugh classes A and B(patient’s score less than 8).Preoperative demographic data,intra-operative data and postoperative details were *** primary outcome measure was hospital mortality *** outcomes analysed included duration of the operation,postoperative hospital stay,postoperative morbidity and survival ***:Only 67/442 patients(15.2%)had cirrhotic *** blood loss and blood transfusion were significantly higher in group A(P=0.0001).The mean surgical time in group A was significantly longer than that in group B(P=0.0001).Wound complications(P=0.02),internal haemorrhage(P=0.05),pancreatic fistula(P=0.02)and hospital mortality(P=0.0001)were significantly higher in the cirrhotic *** stay was significantly longer in group A(P=0.03).The median survival was 19 mo in group A and 24 mo in group *** hypertension(PHT)was present in 16/67 cases of cirrhosis(23.9%).The intraoperative blood loss and blood transfusion were significantly higher in patients with PHT(P=0.001).Postoperative morbidity(0.07)and hospital mortality(P=0.007)were higher in cirrhotic patients with ***:Patients with periampullary tumours and well-compensated chronic liver disease should be routinely considered for PD at high volume centres with available expertise to manage liver *** is associated with an increased risk of postoperative morbidity in patients with liver cirrhosis;therefore,it is only recommended in patients with Child A cirrhosis without portal hypertension.

关键词： Periampullary tumour Liver cirrhosis Portal hypertension Pancreaticoduodenectomy