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Ductal adenocarcinoma of the pancreatic head:A focus on current diagnostic and surgical concepts

World Journal of Gastroenterology 2012年第24期18卷 3058-3069页

作者： Mehdi Ouassi urs giger Guillaume Louis Igor Sielezneff Bernard Sastre Olivier Farges Centre for Research in Oncology and Oncopharmacologie Aix Marseille University13005 MarseilleFrance Department of Oncologic and Digestive Surgery Timone Hospital13385 MarseilleFrance Department of Surgery Marienhospital HerneRuhr University Bochum44625 HerneGermany Department of Radiology Timone Hospital13385 MarseilleFrance Department of Hepato-Biliary Surgery Beaujon Hospital92110 ClichyFrance

Complete surgical resection still remains the only possibility of curing pancreatic cancer,however,only 10% of patients undergo curative *** resection currently remains the only method of curing patients,and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected *** surgery is a technically demanding procedure requiring highly standardized surgical ***,even in experienced hands,perioperative morbidity rates(delayed gastric emptying,pancreatic fistula etc.) are as high as 50%.Different strategies to reduce postoperative morbidity,such as different techniques of gastroenteric reconstruction(pancreatico-jejunostomy vs pancreatico-gastrostomy),intraoperative placement of a pancreatic main duct stent or temporary sealing of the main pancreatic duct with fibrin glue have not led to a significant improvement in clinical *** perioperative application of somatostatin or its analogues may decrease the incidence of pancreatic fistulas in cases with soft pancreatic tissue and a small main pancreatic duct(< 3 mm).The positive effects of external pancreatic main duct drainage and antecolic gastrointestinal reconstruction have been observed to decrease the rate of pancreatic fistulas and delayed gastric emptying,***,the concept of extended radical lymphadenectomy has been found to be associated with higher perioperative morbidity,but without any positive impact on overall ***,there is growing evidence that portal vein resections can be performed with acceptable low perioperative morbidity and mortality but does not achieve a cure.

关键词： Pancreatic adenocarcinoma, Pancreatic fis-tula Pancreatic surgery Venous resection

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Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

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World Journal of Gastroenterology 2010年第24期16卷 3011-3015页

作者： Mehdi Ouassi Silvia Cresti urs giger Igor Sielezneff Nicolas Pirrò Bruno Berthet Philippe Grandval Bernard Consentino Bernard Sastre Department of Visceraland Oncological Surgery Timone Hospital Department of Surgery Kantonsspital Bruderholz Department of gastroenterology Timone Hospital

AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four ***: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.

关键词： Pelvic organ prolapse Recto-vaginal fistula Prosthetic treatment

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