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Whipple’s pancreaticoduodenectomy at a resource-poor,low-volume center in Trinidad and Tobago 被引量:3
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作者 Shamir O Cawich Dexter A Thomas +1 位作者 Neil W Pearce Vijay Naraynsingh 《World Journal of Clinical Oncology》 CAS 2022年第9期738-747,共10页
BACKGROUND Many authorities advocate for Whipple’s procedures to be performed in highvolume centers,but many patients in poor developing nations cannot access these centers.We sought to determine whether clinical out... BACKGROUND Many authorities advocate for Whipple’s procedures to be performed in highvolume centers,but many patients in poor developing nations cannot access these centers.We sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume,resource-poor setting in the West Indies.AIM To study outcomes of Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1,2013 to June 30,2021.METHODS This was a retrospective study of all patients undergoing Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1,2013 to June 30,2021.RESULTS This center performed an average of 11.25 procedures per annum.There were 72 patients in the final study population at a mean age of 60.2 years,with 52.7%having American Society of Anesthesiologists scores≥III and 54.1%with Eastern Cooperative Oncology Group scores≥2.Open Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in 2.Portal vein resection/reconstruction was performed in 19(26.4%)patients.In patients undergoing open procedures there was 367±54.1 min mean operating time,1394±656.8 mL mean blood loss,5.24±7.22 d mean intensive care unit stay and 15.1±9.53 d hospitalization.Six(8.3%)patients experienced minor morbidity,10(14%)major morbidity and there were 4(5.5%)deaths.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 Whipple’s procedures.Low volume centers in resource poor nations can achieve good short-term outcomes.This is largely due to the process of continuous,adaptive learning by the entire hospital. 展开更多
关键词 PANCREAs surgery PANCREATECTOMY whipple’s PANCREATICODUODENECTOMY
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Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers 被引量:2
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作者 Shamir O Cawich Neil W Pearce +2 位作者 Vijay Naraynsingh Parul Shukla Rahul R Deshpande 《World Journal of Clinical Cases》 SCIE 2022年第22期7620-7630,共11页
Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume centers.However,this is not practical in small,resource-poor countries in the Caribbean.In these... Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume centers.However,this is not practical in small,resource-poor countries in the Caribbean.In these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general surgeons.In 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 nations.Specifically,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 Caribbean.This paper has two parts.First,we performed a literature review evaluating studies published on outcomes after PD in high volume centers.The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept.In 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 countries.In these settings,their only options are to have their operations in the resource-poor,low-volume settings in the Caribbean.However,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged. 展开更多
关键词 PANCREAs sURGERY PANCREATECTOMY whipple’s PANCREATICODUODENECTOMY
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Atypical Whipple’s disease with special endoscopic manifestations:A case report 被引量:1
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作者 Shuo Chen Yuan-Chen Zhou +6 位作者 Shuang Si Hong-Yan Liu Qing-Rui Zhang Teng-Fei Yin Chu-Xi Xie Shu-KunYao Shi-Yu Du 《World Journal of Clinical Cases》 SCIE 2022年第35期13044-13051,共8页
BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The... BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The diagnosis often relies on invasive manipulation,pathological examination,and molecular techniques.These difficulties in diagnosing Whipple’s disease often result in misdiagnosis and inappropriate treatments.CASE SUMMARY This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity.The results of routine blood tests indicated hypochromic microcytic anemia.Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum.A diagnosis of small intestinal adenomatosis was initially considered;hence,the Whipple procedure,a pylorus-preserving pancreaticoduodenectomy,was performed.Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum,upper jejunum,and surrounding lymph nodes.Based on comprehensive analysis of symptoms,laboratory findings,and pathological manifestations,the patient was finally diagnosed with Whipple’s disease.After receiving 1 mo of antibiotic treatment,the fatigue and anemia were significantly improved.CONCLUSION This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges,which provided new insight on the diagnosis of Whipple’s disease. 展开更多
关键词 whipple’s disease whipple operation ENDOsCOPY Tropheryma whipplei PAs staining Intestinal polyposis Case report
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Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP
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作者 Rodrigo Garcés-Durán Laurent Monino +2 位作者 Pierre H Deprez Hubert Piessevaux Tom G Moreels 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2024年第5期509-514,共6页
Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of si... Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy. 展开更多
关键词 ENTEROsCOPY Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY PANCREATICODUODENECTOMY surgically altered anatomy whipple’s procedure
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Diagnosis and treatment of Whipple disease after kidney transplantation:A case report
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作者 Qian Chen Yu-Lin Niu Tao Zhang 《World Journal of Clinical Cases》 SCIE 2023年第25期6019-6024,共6页
BACKGROUND Kidney transplantation is the standard treatment for end-stage renal disease.Particularly,rare and specific pathogenic infections which are asymptomatic are often difficult to diagnose,causing delayed and i... BACKGROUND Kidney transplantation is the standard treatment for end-stage renal disease.Particularly,rare and specific pathogenic infections which are asymptomatic are often difficult to diagnose,causing delayed and ineffective treatment and thus seriously affecting prognosis.Tropheryma whipplei(T.whipplei)is a Gram-positive actinomycete widely found in soil,sewage,and other external environments and is present in the population as an asymptomatic pathogen.There is relatively little documented research on T.whipplei in renal transplant patients,and there are no uniform criteria for treating this group of post-transplant patients.This article describes the treatment of a 42-year-old individual with post-transplant T.whipplei infection following kidney transplantation.CASE SUMMARY To analyze clinical features of Whipple’s disease and summarize its diagnosis and treatment effects after renal transplantation.Clinical data of a Whipple’s disease patient treated in the affiliated hospital of Guizhou Medical University were collected and assessed retrospectively.The treatment outcomes and clinical experience were then summarized via literature review.The patient was admitted to the hospital due to recurrent diarrhea for 1 mo,shortness of breath,and 1 wk of fever,after 3 years of renal transplantation.The symptoms of the digestive and respiratory systems were not significantly improved after adjusting immunosuppressive regimen and anti-diarrheal,empirical antibiotic treatments.Bronchoscopic alveolar fluid was collected for meta-genomic next-generation sequencing(mNGS).The deoxyribonucleic acid sequence of Tropheryma whipplei was detected,and Whipple’s disease was diagnosed.Meropenem,ceftriaxone,and other symptomatic treatments were given,and water-electrolyte balance was maintained.Symptoms resolved quickly,and the patient was discharged after 20 d of hospitalization.The compound sulfamethoxazole tablet was continued for 3 mo after discharge.No diarrhea,fever,and other symptoms occurred during the 6-month follow-up.CONCLUSION Whipple’s disease is rare,with no specific symptoms,which makes diagnosis difficult.Polymerase chain reaction or mNGS should be immediately performed when the disease is suspected to confirm the diagnosis. 展开更多
关键词 Kidney transplantation IMMUNOsUPPREssION whipple disease whipple’s nutrient barrier Macrogenomics secondgeneration sequencing technology Case report
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How to treat intestinal obstruction due to malignant recurrence after Whipple's resection for pancreatic head cancer: description of 2 new endoscopic techniques 被引量:3
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作者 Christina Mouradides Alaa Taha +2 位作者 Ivan Borbath Pierre H Deprez Tom G Moreels 《World Journal of Gastroenterology》 SCIE CAS 2017年第33期6181-6186,共6页
The prognosis of pancreatic cancer remains poor,even after initial surgical therapy. Local recurrence after Whipple's pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb o... The prognosis of pancreatic cancer remains poor,even after initial surgical therapy. Local recurrence after Whipple's pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a selfexpandable metal stent(SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple's resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing Hot Axios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple's resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed. 展开更多
关键词 Intestinal obstruction self-expandable metal stent whipple’s pancreatico-duodenectomy
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First Pillcam Colon 2 capsule images of Whipple's disease:Case report and review of the literature 被引量:1
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作者 Bogdan Radu Mateescu Andreea Bengus +3 位作者 Madalina Marinescu Florica Staniceanu Gianina Micu Lucian Negreanu 《World Journal of Gastrointestinal Endoscopy》 CAS 2012年第12期575-578,共4页
Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei.The infection usually mainly involves the small bowel,but sometimes other organs are affected as ... Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei.The infection usually mainly involves the small bowel,but sometimes other organs are affected as well.Since the current standard clinical and biological tests are nonspecific,diagnosis is very difficult and relies on histopathology.Here we present the case of a 52-yearold man with chronic diarrhea and weight loss whose symptoms had been evolving for 2 years and whose diagnosis came unexpectedly after capsule examination.Diagnosis was confirmed by the histopathologic examination of endoscopic biopsy samples,and treatment with co-trimoxazole resulted in remission of symptoms.We present the first images of Whipple's disease obtained with the Pillcam Colon 2 video capsule system. 展开更多
关键词 whipple’s DIsEAsE MALABsORPTION CAPsULE ENDOsCOPY Pillcam COLON 2
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Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team
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作者 Vasileios K Mavroeidis Jennifer Knapton +1 位作者 Francesca Saffioti Daniel L Morganstein 《World Journal of Diabetes》 SCIE 2024年第4期598-605,共8页
Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralis... Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined,a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis.Therefore,pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams.With the ongoing accumulation of evidence,it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients. 展开更多
关键词 PANCREATECTOMY PANCREATODUODENECTOMY whipple’s PANCREATITIs Diabetes specialist Type 3c pancreatogenic diabetes mellitus
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Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres 被引量:3
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作者 Shamir O Cawich Michael D Kluger +6 位作者 Wesley Francis Rahul R Deshpande Fawwaz Mohammed Kimon O Bonadie Dexter A Thomas Neil W Pearce Beth A Schrope 《World Journal of Gastrointestinal Surgery》 SCIE 2021年第10期1122-1135,共14页
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 difficult.The concept of service centra... 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 difficult.The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries.However,this is not the environment that many surgeons in developing countries work in.These patients often do not have the opportunity to travel to high volume centres for care.Therefore,we sought to review the existing data on MIS for the pancreas and to discuss.In 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 Caribbean.This paper has two parts.First,we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the pancreas.The data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital practice.Low 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 environment.This 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. 展开更多
关键词 PANCREAs surgery LAPAROsCOPIC Minimally invasive PANCREATECTOMY whipple’s Pancreaticoduidenectomy
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Long-term survival after pancreaticoduodenectomy in patients with ductal adenocarcinoma of the pancreatic head 被引量:1
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作者 Andreas Minh Luu Chris Braumann +4 位作者 Orlin Belyaev Monika Janot-Matuschek Henrik Rudolf Michael Praktiknjo Waldemar Uhl 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2021年第3期271-278,共8页
Background: Pancreatic ductal adenocarcinoma(PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to syst... Background: Pancreatic ductal adenocarcinoma(PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to systemic treatment. Complete tumor resection remains the cornerstone of modern multimodal strategies aiming at long-term survival. This study was performed to investigate the overall rate of long-term survival(LTS) and its contributing factors. Methods: This was a retrospective single-center analysis of consecutive patients undergoing pancreaticoduodenectomy(PD) for PDAC between 2007 and 2014 at the St. Josef Hospital, Ruhr University Bochum, Germany. Clinical and laboratory parameters were assessed and evaluated for prediction of LTS with Cox regression analysis. Results: The overall rate of LTS after PD for PDAC was 20.4%(34/167). Median survival was 24 months regardless of adjuvant treatment. Carbohydrate antigen 19-9 levels, tumor grade, lymph vessel invasion, perineural invasion and reduced general condition were significantly associated with LTS in univariate analysis( P<0.05). Serum levels of carbohydrate antigen 19-9, American Joint Committee on Cancer stage, tumor grade, abdominal pain, male, exocrine pancreatic insufficiency and duration of postoperative hospital stay were independent predictors of cancer survival in multivariable analysis. Conclusions: Cancer related characteristics are associated with LTS in multimodally treated patients after curative PDAC surgery. 展开更多
关键词 PANCREATICODUODENECTOMY whipple’s procedure Pancreatic cancer survival Ductal adenocarcinoma PANCREAs Pancreatic surgery
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Post-bulbar duodenal ulcer with anterior perforation with kissing ulcer and duodenocaval fistula:A case report and review of literature 被引量:1
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作者 Nasser Alzerwi 《World Journal of Clinical Cases》 SCIE 2022年第25期9071-9077,共7页
BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duo... BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duodenocaval fistula(DCF)is another uncommon but potentially fatal complication related to PBDU.There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain,stiffness,and vomiting.The X-ray showed pneumoperitoneum,suggesting a perforated viscus.Laparotomy revealed a KU with anterior perforation and a DCF.After Kocherization,venorrahphy was used to control caval bleeding.Due to the critical condition of the patient,only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy.However,later,the patient developed obstructive jaundice and leakage,and two additional jejunal perforations were detected.Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer,neither primary repair nor pancreatic-free duodenectomy and ampull-oplasty/ampullary reimplantation were considered viable;therefore,an emergency pancreaticoduodenectomy was performed,along with resection and anastomosis of the two jejunal perforations.The patient had a smooth recovery after surgery and was discharged after 27 d.CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients,even in the most complex cases. 展开更多
关键词 Duodenal ulcer Duodenocaval fistula Kissing ulcer Emergency whipple’s surgery Case report
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