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rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande rahul r deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGrOUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for *** ability to rescue patients from post-PD complications is as a recognized quality *** protocols were instituted at our low volume facility in the year *** To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of *** A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,***-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD *** Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this *** complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their ***(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring *** low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major *** attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protoc

关键词： Pancreas Complication rescue Failure Morbidity Mortality Pancreaticoduodenectomy

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Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers

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World Journal of Clinical Cases 2022年第22期10卷 7620-7630页

作者： Shamir O Cawich Neil W Pearce Vijay Naraynsingh Parul Shukla rahul r deshpande Department of Clinical Surgical Sciences University of the West IndiesSt Augustine 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom

Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume ***,this is not practical in small,resource-poor countries in the *** these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general *** this paper,we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income ***,we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries,such as those in the *** paper has two ***,we performed a literature review evaluating studies published on outcomes after PD in high volume *** data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization *** the authors’opinions,most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed *** these settings,their only options are to have their operations in the resource-poor,low-volume settings in the ***,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged.

关键词： Pancreas Surgery Pancreatectomy Whipple’s Pancreaticoduodenectomy

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review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres

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World Journal of Gastrointestinal Surgery 2021年第10期13卷 1122-1135页

作者： Shamir O Cawich Michael D Kluger Wesley Francis rahul r deshpande Fawwaz Mohammed Kimon O Bonadie Dexter A Thomas Neil W Pearce Beth A Schrope Clinical Surgical Sciences University of the West IndiesTunapuna 331333Trinidad and Tobago Department of Surgery New York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY 10032United States Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Clinical Surgical Sciences University of the West IndiesTunapuna 331333Trinidad and Tobago Department of Surgery Health Service AuthorityGeorgetown 915 GTCayman Islands Department of Surgery Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Columbia University College of Physicians and SurgeonsNew YorkNY 10032United States

Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery(MIS)because there are many factors that make laparoscopic pancreas resections *** concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich ***,this is not the environment that many surgeons in developing countries work *** patients often do not have the opportunity to travel to high volume centres for ***,we sought to review the existing data on MIS for the pancreas and to *** this paper,we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries,such as those in the *** paper has two ***,we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the *** data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital *** pancreatic case volume in the Caribbean,and financial barriers to MIS in general,laparoscopic distal pancreatectomy,enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare *** is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.

关键词： Pancreas Surgery Laparoscopic Minimally invasive Pancreatectomy Whipple’s Pancreaticoduidenectomy

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Surgical relevance of anatomic variations of the right hepatic vein

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World Journal of Transplantation 2021年第6期11卷 231-243页

作者： Shamir O Cawich Vijay Naraynsingh Neil W Pearce rahul r deshpande robbie rampersad Michael T Gardner Fawwaz Mohammed roma Dindial Tanzilah Afzal Barrow Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of radiology University of the West IndiesSt.Augustine 000000Trinidad and Tobago Department of radiology Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of radiology University of the West IndiesSt Augustine 000000Trinidad and Tobago

BACKGrOUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons,interventional radiologists,and other medical practitioners who treat liver *** drainage patterns of the right hepatic veins(rHVs)are particularly relevant to transplantation *** The aim was to identify variations of the patterns of venous drainage from the right side of the *** the best of our knowledge,there have been no reports on rHV variations in in a Caribbean *** Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral *** outflow patterns were observed and rHV variants were described as:(1)Tributaries of the rHV;(2)Variations at the hepatocaval junction(HCJ);and(3)Accessory *** A total of 118 scans met the inclusion *** 39%of the scans found conventional anatomy of the main hepatic *** rHVs were present 49.2%and included a well-defined inferior rHV draining segment VI(45%)and a middle rHV(4%).At the HCJ,83 of the 118(70.3%)had a superior rHV that received no tributaries within 1 cm of the junction(Nakamura and Tsuzuki type I).In 35 individuals(29.7%)there was a short superior rHV with at least one variant *** to the Nakamura and Tsuzuki classification,there were 24 type II variants(20.3%),six type III variants(5.1%)and,five type IV variants(4.2%).CONCLUSION There was significant variation in rHV patterns in this population,each with important relevance to liver *** radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

关键词： Liver Variant Hepatic Vein Anomaly Venous,Drainage,Vena cava

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Anatomic variations of the intra-hepatic biliary tree in the Caribbean:A systematic review

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World Journal of Gastrointestinal Endoscopy 2021年第6期13卷 170-183页

作者： Shamir O Cawich Alexander Sinanan rahul r deshpande Michael T Gardner Neil W Pearce Vijay Naraynsingh Department of Clinical Surgical Sciences University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Anatomy University of the West IndiesKingston KIN7Jamaica Department of Surgery Southampton University NHS TrustSouthampton SO16DPSouthamptonUnited Kingdom

BACKGrOUND In the classic descriptions of the human liver,the common hepatic duct forms at the confluence of left and right hepatic *** authors have documented variations in the intra-hepatic ductal system,but to the best of our knowledge there has been no report on bile duct variations in Caribbean *** To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography(MrC)in unselected patients at a major hepatobiliary referral centre in the Eastern *** of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary *** This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern *** retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1,2017 to March 31,*** consultant radiologists experienced in MrC interpretation reviewed all scans and described biliary anatomy according to the Huang’s classification.A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary *** variants in our population were compared to the global *** There were 152 MrCs evaluated in this study in 86 males and 66 *** were 109(71.7%)persons with“classic”biliary anatomy(type A1)and variants were present in 43(28.3%)*** was no statistical relationship between the presence of anatomic variants and gender or *** encountered the following variants:29(19.1%)type A2,7(4.6%)type A3,6(3.95%)type A4,0 type A5 and a single variant(quadrification)that did not fit the classification *** to the global prevalence,our population had a significantly greater occurrence of A1 anatomy(71.7%vs 62.6%;P=0.0227)and A2 trifurcations(19.1%vs 11.5%;P=0.0069),but a significantly lower incidence of A3 varian

关键词： Liver Variant Biliary Duct Intra-hepatic Aberrant Trifurcation,Bifurcation

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Pseudoaneurysm following laparoscopic cholecystectomy

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Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 294-298页

作者： Mansoor Ahmed Madanur Narendra Battula Harsheet Sethi rahul deshpande Nigel Heaton Mohamed rela Institute of Liver Studies Kings College Hospital Denmark HillLondon SE5 9RSUK

BACKGrOUND:Laparoscopic cholecystectomy(LC)is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic *** has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm *** to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. rESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these,4 patients (4.5%)developed hepatic artery pseudoaneurysm(HAP) presenting with haemobilia in 3 and massive intra- abdominal bleed in *** visceral angiography confirmed pseudoaneurysm of the right hepatic artery in 2 cases,cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth *** hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic *** the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct. . (CHD)requiring hepatico-jejunostomy and one developed a stricture of left hepatic *** the 4 patients are alive at a median follow up of 17 months(range 1 to 65)with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life- threatening complication of *** and subsequent infection are reported to be associated with pseudoaneurysm *** du

关键词： laparoscopic cholecystectomy bile leaks infection hepatic artery pseudoaneurysm

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