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Utility of routine blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones

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World Journal of Gastrointestinal Surgery 2017年第6期9卷 149-152页

作者： offir ben.ishay Marina Zeltser Yoram Kluger Surgical Oncology Pancreatic and Hepatobiliary Surgery ServiceDepartment of General SurgeryDivision of SurgeryRambam Health Care CampusHaifa 35254Israel

AIM To evaluate the value of blood testing after elective laparoscopic cholecystectomy and its association with procedure related *** Charts of all patients undergoing elective laparoscopic cholecystectomy from January 2013 through December2014 were reviewed retrospectively for demographics,indication for surgery,operative course and *** our institution the decision to perform postoperative blood analysis is left for the discretion of the surgeon,therefore we had the possibility to compare the results of those who had blood analyses results to those who did *** was performed to identify variables associated with the decision to perform postoperative blood *** a univariate and multivariate analyses was performed comparing the two *** subgroup analysis was performed to identify factors associated with procedure related *** Five hundred and thirty-two elective laparoscopic cholecystectomies for symptomatic gallstones were performed during the study ***-four percent of the patients(n=340)had blood tests taken post *** that had laboratory tests taken were older(P=0.006,OR=1.01),had longer surgery(Pbenefit in diagnosis and management of cases w

关键词： Cholecystectomy Blood tests Laparoscopy Complications Post-operative Gallstones symptomatic

Dual loop(Roux en Y) reconstruction with isolated gastric limb reduces delayed gastric emptying after pancreatico-duodenectomy

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 93-100页

作者： offir ben.ishay Reem Abu Zhaya Yoram Kluger Surgical Oncology Unit Division of General Surgery Rambam Health Care Campus

BACKGROUND Single loop reconstruction(SLR) was routine in our institution for patients undergoing pancreatico-duodenectomy(PD). Roux-en Y reconstruction with an isolated gastric limb(RIGL) recently became the reconstruction of *** To evaluate the impact of RIGL on incidence and severity of delayed gastric emptying(DGE).METHODS This is a single institution, retrospective analysis of patients undergoing PD. All patients undergoing PD from July 2010 through December 2016 were included in the study. Outcome of RIGL were compared to SLR. Primary measure of outcome included incidence and severity of DGE. Secondary measures of outcome were overall complications and postoperative *** One hundred and seventy-nine patients were included in the study. Fifty-two had RIGL, 127 had SLR. Overall complication rate was 40.2%, patients in the RIGL group experienced lower rates of DGE(15.4% vs 59.1%, P = 0.001). Other patient related outcomes were also significantly reduced: day of nasogastric tube removal(3 vs 5, P < 0.001), regain of normal diet(8 vs 9, P < 0.001). On multivariate analysis RIGL was associated independently with reduced rates of DGE(P < 0.001, OR 0.14)CONCLUSION The current study shows that RIGL reduces the rate of DGE after PD. Further prospective randomized controlled trials are required to affirm the current data.

关键词： Pancreaticoduodenectomy Delayed gastric emptying Complications Roux en Y

Clinical presentation predicts the outcome of patients with colon cancer

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World Journal of Gastrointestinal Surgery 2013年第4期5卷 104-109页

作者： offir ben.ishay Zvi Peled Amira Othman Eran Brauner Yoram Kluger Department of General Surgery Rambam Health Care Campus the Ruth and Bruce Rappaport Faculty of Medicine Technion Israel Institute of Technology

AIM: To elucidate the relationship between clinical presentation and outcome. METHODS: A single institution retrospective chart review of patients admitted with the diagnosis of colon cancer. We used univariate and a multivariate analysis to identify symptoms association with mortality. An odds ratio based clinical score was created to evaluate the contribution of the quality of symptoms to outcome. Primary measure of outcome was survival. RESULTS: During the study period, 236 patients met the inclusion criteria. Overall survival was 60.6%, mean follow-up 3.0 years. A bivariate analysis showed that increasing number of symptoms is not associated with mortality. However, a symptom-specific analysis performed using a logistic regression model controlling for age, stage and the duration of complaints revealed that the presence of melena was independently associated with mortality [P = 0.04, odds ratio (OR) 7.4],while rectal bleeding was associated with survival (P = 0.004, OR 3.9). Applying the proposed clinical score to an receiver operating characteristic curve showed that score > 1 had a strong association with mortality. The same logistic regression model was applied. The results showed that a score > 1 was an independent predictor of mortality (P < 0.001) and associated with node-positive disease (P = 0.008). CONCLUSION: The quality of symptoms rather than quantity is correlated with outcome among patients with colon cancer. The proposed clinical scoring system may correctly predict the patient's outcome.

关键词： Colon cancer Symptoms Mortality

Autoimmune pancreatitis misdiagnosed as a tumor of the head of the pancreas

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World Journal of Gastrointestinal Surgery 2012年第7期4卷 185-189页

作者： Eran Brauner Jesse Lachter offir ben.ishay Euvgeni Vlodavsky Yoram Kluger Department of General Surgery B Rambam Health Care Campus31096 HaifaIsrael Department of Gastroenterology Rambam Health Care Campus31096 HaifaIsrael Department of Pathology Rambam Health Care Campus31096 HaifaIsrael

Autoimmune pancreatitis can mimic pancreatic cancer in its clinical presentation, imaging features and laboratory parameters. Differentiating between those two entities requires implementation of clinical judgment and experience along with objective parameters that may suggest either condition. Few strategies have been proposed for the surgeon to implement when facing borderline cases. The following case is an example of a clinical scenario compatible with an accepted algorithm for diagnosis of pancreatic cancer, which eventually proved wrong. We present a 75-year-old patient who was admitted for obstructive jaundice. Imaging features were highly suggestive for pancreatic cancer as was the carbohydrate antigen 19-9 (CA 19-9) level, leading to a decision for surgery. Pathological examination revealedautoimmune pancreatitis. Though no frank carcinoma was found, premalignant ductal changes of pancreatic intraepithelial neoplasia (PanIN)Ⅰand PanIN Ⅱ were discovered throughout the pancreatic duct. Caution is advised when relying on the combination of highly suggestive radiology features and elevated levels of CA 19-9 in the diagnosis of pancreatic cancer. When the tissue diagnosis is not conclusive, obtaining IgG4 and antinuclear Ab levels is advised, to rule out the rare possibility of autoimmune pancreatitis. Patients with autoimmune pancreatitis should be followed carefully as precancerous lesions may accompany the benign disease and the correlation of these two entities has not been ruled out.

关键词： Autoimmune pancreatitis Carbohydrate antigen 19-9 Pancreatic cancer Pancreatic intraepithelial neoplasia