Consequences of metabolic syndrome on postoperative outcomes after pancreaticoduodenectomy

AIM To analyze immediate postoperative outcomes after pancreaticoduodenectomy regarding metabolic syndrome.METHODS In two academic centers, postoperative outcomes of patients undergoing pancreaticoduodenectomy from 2002 to 2014 were prospectively recorded. Patients presenting with metabolic syndrome [defined as at least three criteria among overweight(BMI ≥ 28 kg/m2), diabetes mellitus, arterial hypertension and dyslipidemia] were compared to patients without metabolic syndrome.RESULTS Among 270 consecutive patients, 29(11%) presented with metabolic syndrome. In univariable analysis, patients with metabolic syndrome were significantly older(69.4 years vs 62.5 years, P = 0.003) and presented more frequently with soft pancreas(72% vs 22%, P = 0.0001). In-hospital morbidity(83% vs 71%) and mortality(7% vs 6%) did not differ in the two groups so as pancreatic fistula rate(45% vs 30%, P = 0.079) and severity of pancreatic fistula(P = 0.257). In multivariable analysis, soft pancreas texture(P = 0.001), pancreatic duct diameter < 3 mm(P = 0.025) and BMI > 30 kg/m2(P = 0.041) were identified as independent risk factors of pancreatic fistula after pancreaticoduodenectomy, but not metabolic syndrome.CONCLUSION In spite of logical reasoning and appropriate methodology, present series suggests that metabolic syndrome does not jeopardize postoperative outcomes after pancreaticoduodenectomy. Therefore, definition of metabolic syndrome seems to be inappropriate and fatty pancreas needs to be assessed with an international consensual histopathological classification.

A rare cause of obstructive jaundice and gastric outlet obstruction

Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal obstruction,and is characterized by 3 rd duodenal obstruction between the abdominal aorta and the superior mesenteric artery.Classical symptoms are postprandial epigastric pain,nausea,vomiting,and weight loss,or acute upper gastrointestinal obstruction.We herein describe an unusual presentation,with jaundice due to compression of the common bile duct by the gastric obstruction and dilated duodenum.

Trichobezoar:A rare cause of bowel obstruction

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. A trichobezoar is a bezoar made up of hair and is a rare cause of bowel obstruction of the proximal gastrointes-tinal tract. They are seen mostly in young women with trichotillomania and trichotillophagia and symptoms include epigastric pain, nausea, loss of appetite and bowel or gastric outlet obstruction. We herein describe a case of a trichobezoar that presented as a gastric outlet obstruction and was subsequently successfully removed via a laparotomy.

Algorithm-based care for early recognition and management of complications after pancreatic resection:toward standardization of postoperative care

This stepped-wedge cluster randomized study(1)included all pancreatectomies performed from 17 Dutch pancreatic surgery centers(all realizing>20 pancreaticoduodenectomies per year)over 22 months.The aim was to demonstrate the value of an algorithm for the early diagnosis and management of postoperative complications.This algorithm determined when to do abdominal computed tomography(CT)scan,radiological drainage,start antibiotic treatment,and remove abdominal drains.It was calculated every day from postoperative day 3 to 14.The primary endpoint was a composite of bleeding that required invasive intervention,organ failure and 90-day mortality.