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Long-term outcome of gastric access loop in hepaticojejunostomy

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 152-155页

作者： Eswaran Selvakumar Shanmugasundaram Rajendran tirupporur g. balachandar Devy gounder Kannan Satyanesan Jeswanth Palaniappan Ravichandran Rajagopal Surendran Department of Surgical gastroenterology Center for G.I.Bleed & Division of Hepatobiliary Pancreatic Diseases Government Stanley Medical College Hospital The Tamilnadu Dr. M.G.R. Medical University Chennai-600001 Tamilnadu India

BACKgROUND:?The incidence of hepaticojejunostomy stricture is 4%-10% in experienced centres. Many access loops have been designed and used to facilitate endoscopic intervention for this complication of hepaticojejunostomy. In this study, we investigated the effectiveness and safety of gastric access loop. METHODS:A retrospective analysis was conducted on 13 patients who had undergone hepaticojejunostomy with gastric access loop between June 1999 and September 2003. Eleven patients were followed up for a mean period of 51 months (range 20-81 months). Two patients were lost to follow up. RESULTS:?On follow-up, 8 patients had patent jejuno- gastrostomy (end to side anastomosis between Roux loop of jejunum and stomach) and hepaticojejunostomy. Three patients developed stricture of jejunogastrostomy at 41 months, 63 months and 81 months of follow-up. Among these 3 patients, one also had hepaticojejunostomy stricture. In the patient with hepaticojejunostomy stricture, dilatation of jejunogastrostomy stricture was attempted but failed. None of the patients had any evidence of bile gastritis/cholangitis. There was no procedure related morbidity/mortality. CONCLUSIONS:Further studies involving large numbers of patients are required before wide application of gastric access loop in hepaticojejunostomy though it is a safer option than percutaneous transhepatic manipulations or revision surgery.

关键词： access loop hepaticojejunostomy anastomotic stricture biliary stricture

Neuroendocrine carcinoma of the ampulla of Vater:a clinicopathologic evaluation

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 422-425页

作者： Eswaran Selvakumar Shanmugasundaram Rajendran tirupporur govindaswamy balachandar Devy gounder Kannan Satyanesan Jeswanth Palaniappan Ravichandran Rajagopal Surendran Department of Surgical gastroenterology Center for G.I.Bleeding & Division of Hepatobiliary Pancreatic Diseases Government Stanley Medical College Hospitalthe Tamilnadu Dr. M.G.R.Medical UniversityChennai 600001TamilnaduIndia

BACKgROUND:Only 105 cases of neuroendocrine tumor(NET)of the ampulla of Vater have been described, mostly as single case *** incidence of NET is *** changes in incidence may result from changes in *** study was to determine the relative incidence and clinicopathological characteristics of high- grade neuroendocrine carcinoma(small cell carcinoma and large cell carcinoma)of the ampulla of Vater at a single institution. METHODS:Sections from paraffin blocks of tumors of the ampulla of Vater taken from 45 patients who underwent Whipple’s procedure and 6 patients who underwent palliative bypass between September 2003 and January 2007 were subjected to immunohistochemical *** clinical and pathological data from 5 patients diagnosed with NET of the ampulla of Vater were analyzed. RESULTS:The patients were 3 men and 2 women,ranging in age from 39 to 47 years(mean 44 years).Operative procedures included Whipple’s procedure in 4 patients and palliative bypass in 1 *** examination revealed large-cell neuroendocrine carcinoma in 2 patients,small cell carcinoma in 2,and carcinoid in *** patients with high-grade neuroendocrine carcinoma who had undergone Whipple’s procedure died at postoperatively 7,11,and 13 *** patient who had undergone palliative triple bypass died 3 months after ***:The relative incidence of high-grade neuroendocrine carcinomas of the ampulla of Vater is higher than that generally *** tumors behave aggressively and have a dismal prognosis despite aggressive treatment.

关键词： neuroendocrine tumor carcinoid tumor ampulla of Vater Whipple's procedure

Outcome of severe acute pancreatitis: Is there a role for conservative management of infected pancreatic necrosis?

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 599-604页

作者： Amarapathy Sivasankar Devy gounder Kannan Palaniappan Ravichandran Sathyanesan Jeswanth tirupporur govindasamy balachandar Rajagopal Surendran Department of Surgical gastroenterology Government Stanley Medical College Hospital the Tamilnadu Dr. M.G.R. Medical University Chennai India

BACKgROUND: Infected pancreatic necrosis is associated with high morbidity and mortality and is mandatory for surgical or radiological intervention. A selected group of patients with CT evidence of infected pancreatic necrosis and a comparatively lower APACHE score may be clinically stable throughout the course of their illness. METHODS: Case records of 52 patients with severe acute pancreatitis admitted from October 2000 to September 2005 were retrospectively analysed to assess the feasibility of conservative management of infected pancreatic necrosis. CT evidence of retroperitoneal air pockets, deteriorated clinical condition, sepsis and positive blood culture were used to diagnose infected pancreatic necrosis. RESULTS: In the 52 male patients reviewed, 24 patients had infected pancreatic necrosis. Eighteen patients who had progressively deteriorated clinical conditions required surgical intervention; five patients of whom (27.8%) died. Six patients with transient end organ dysfunction and stable clinical conditions were treated with prolonged administration of antibiotics and ICU support. All these patients recovered and discharged from the hospital, and no symptoms or readmission happened during follow-up of 6-44 months. CONCLUSIONS: Selected patients with infected pancreatic necrosis who are clinically stable with transient end organ dysfunction can be treated conservatively with a favourable outcome. Necrosectomy associated with high morbidityand mortality in these patients can be avoided. The need for intervention should be individualized and based on clinical conditions of the patients.

关键词： acute necrotizing pancreatitis APACHE Ⅱ multiple organ dysfunction syndrome mortality antibiotics