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Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

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World Journal of Gastrointestinal Surgery 2017年第3期9卷 82-91页

作者： Jake E krige Eduard Jonas Sandie R Thomson urda k kotze Mashiko Setshedi Pradeep H Navsaria Andrew J Nicol Surgical Gastroenterology Unit Department of Surgery University of Cape Town Health Sciences Faculty Observatory Groote Schuur Hospital Observatory Department of Medicine University of Cape Town Health Sciences Faculty Department of Surgery Trauma Centre University of Cape Town Health Sciences Faculty Observatory

AIM To benchmark severity of complications using the Accordion Severity Grading System(ASGS) in patients undergoing operation for severe pancreatic injuries. METHODS A prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection(pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage controllaparotomy(DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni-and multivariate logistic regression analysis was applied. RESULTS Overall 238 complications occurred in 95(73%) patients of which 73% were ASGS grades 3-6. Nineteen patients(14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score(RTS) ked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy(PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS k on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection(PD) were significant. CONCLUSION This ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

关键词：胰损害复杂并发症手风琴分类

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Aorto-oesophageal fistula after corrosive ingestion:A case report

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 506-513页

作者： Matthias Frank Scriba urda kotze Nadraj Naidoo Eduard Jonas Galya Eileen Chinnery Surgical Gastroenterology Unit Department of SurgeryGroote Schuur HospitalUniversity of Cape TownCape Town 7925Western CapeSouth Africa Surgical Gastroenterology Unit Department of SurgeryUniversity of Cape TownFaculty of Health SciencesCape Town 7925Western CapeSouth Africa Vascular and Endovascular Surgery Unit Department of SurgeryGroote Schuur HospitalUniversity of Cape TownCape Town 7925Western CapeSouth Africa

BACkGROUND Aorto-oesophageal fistula(AOF)are uncommon and exceedingly rare after corrosive *** authors report a case of AOF after corrosive ingestion that survived.A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition,how it is best managed and what the outcomes *** SUMMARY A previously healthy 30-year-old male,presented with a corrosive oesophageal injury after drain cleaner *** did not require acute surgical resection,but developed long-segment oesophageal stricturing,which was initially managed with cautious dilatation and later *** AOF was suspected at endoscopy performed two months after the ingestion,when the patient represented with massive upper gastrointestinal *** fistula was confirmed on computerised tomographic *** initial bleeding at endoscopy was temporised by oesophageal stenting;a second stent was placed when bleeding recurred later the same *** stenting successfully achieved temporary bleeding control,but resulted in sudden respiratory distress,which was found to be due to left main bronchus compression caused by the overlapping oesophageal *** bleeding control was achieved by endovascular aortic stent-grafting.A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft *** was subsequently successfully discharged and remains well one year post *** AOF after corrosive ingestion is exceedingly rare,with a very high *** occur weeks to months after the initial corrosive *** management is ill-advised.

关键词： Aorto-oesophageal fistula Corrosive/caustic injury Corrosive ingestion Case report

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Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting

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World Journal of Gastrointestinal Pathophysiology 2023年第2期14卷 34-45页

作者： Jake krige Eduard Jonas Chanel Robinson Steve Beningfield urda kotze Marc Bernon Sean Burmeister Christo kloppers Department of Surgical Gastroenterology University of Cape Town Health Sciences FacultyCape Town 7925Western CapeSouth Africa Department of Radiology University of Cape Town Health Sciences FacultyCape Town 7925Western CapeSouth Africa Department of Surgical Gastroenterology University of Cape TownFaculty of Health SciencesCape Town 7925Western CapeSouth Africa

BACkGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is now established as the salvage procedure of choice in patients who have uncontrolled or severe recurrent variceal bleeding despite optimal medical and endoscopic *** To analysis compared the performance of eight risk scores to predict in-hospital mortality after salvage TIPS(sTIPS)placement in patients with uncontrolled variceal bleeding after failed medical treatment and endoscopic *** Baseline risk scores for the Acute Physiology and Chronic Health Evaluation(APACHE)II,Bonn TIPS early mortality(BOTEM),Child-Pugh,Emory,FIPS,model for end-stage liver disease(MELD),MELD-Na,and a novel 5 category CABIN score incorporating Creatinine,Albumin,Bilirubin,INR and Na,were calculated before ***(C)statistics for predictive accuracy of inhospital mortality of the eight scores were compared using area under the receiver operating characteristic curve(AUROC)*** Thirty-four patients(29 men,5 women),median age 52 years(range 31-80)received sTIPS for uncontrolled(11)or refractory(23)bleeding between August 1991 and November *** TIPS controlled bleeding in 32(94%)patients with recurrence in ***(29%)patients died in *** scoring systems had a significant association with in-hospital mortality(Pk *** sTIPS,hospital mortality remains high and can be predicted by CABIN category B or C or CABIN scores>*** was 100%in CABIN A patients while mortality was 75%for CABIN B,87.5%for CABIN C,and 83%for CABIN scores>10.

关键词： Transjugular intrahepatic portosystemic shunt Risk score Portal hypertension Variceal bleeding Mortality

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Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 365-377页

作者： Jake krige Eduard Jonas urda kotze Christo kloppers karan Gandhi Hisham Allam Marc Bernon Sean Burmeister Mashiko Setshedi Departments of Surgery and Medicine University of Cape Town Health Sciences FacultyCape Town 7925South Africa Department of Surgery University of Cape Town Health Sciences FacultyCape Town 7925South Africa

BACkGROUND Bleeding esophageal varices(BEV)is a potentially life-threatening complication in patients with portal hypertension with mortality rates as high as 25%within six weeks of the index variceal *** control of the initial bleeding episode patients should enter a long-term surveillance program with endoscopic intervention combined with non-selectiveβ-blockers to prevent further bleeding and eradicate *** To assess the efficacy of endoscopic variceal ligation(EVL)in controlling acute variceal bleeding,preventing variceal recurrence and rebleeding and achieving complete eradication of esophageal varices(EV)in patients who present with *** A prospectively documented single-center database was used to retrospectively identify all patients with BEV who were treated with EVL between 2000 and *** of acute bleeding,variceal recurrence,rebleeding,eradication and survival were analyzed using Baveno assessment *** One hundred and forty patients(100 men,40 women;mean age 50 years;range,21-84 years;Child-Pugh grade A=32;B=48;C=60)underwent 160 emergency and 298 elective EVL interventions during a total of 928 endoscopy *** hundred and fourteen(81%)of the 140 patients had variceal bleeding that was effectively controlled during the index banding procedure and never bled again from EV,while 26(19%)patients had complicated and refractory variceal *** controlled the acute sentinel variceal bleed during the first endoscopic intervention in 134 of 140 patients(95.7%).Six patients required balloon tamponade for control and 4 other patients rebled in *** 5-d endoscopic failure to control variceal bleeding was 7.1%(n=10)and four patients required a salvage transjugular intrahepatic portosystemic *** admission mortality was 14.2%(n=20).EV were completely eradicated in 50 of 111 patients(45%)who survived>3 mo of whom 31 recurred and 3 ***(13.3%)of 120 surviving patients subsequently had 21 EV re

关键词： Endoscopy Variceal ligation Variceal bleeding Secondary prophylaxis Esophageal varices Variceal recurrence

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