Blumgart's technique of pancreaticojejunostomy: Analysis of safety and outcomes

Background: Blumgart's pancreaticojejunostomy(PJ) has been described with low pancreatic leak rates. This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative outcomes. Methods: We performed a single-center retrospective analysis of a cohort of 81 patients who underwent pancreaticoduodenectomy in our department from January 2011 to February 2018. The primary endpoint was the occurrence of a clinically relevant postoperative pancreatic fistula(CR-POPF) and analysis of its risk factors. Results: The CR-POPF rate was 12.3%. Fistula risk score(FRS) was the only significant risk factor for the occurrence of overall POPF in multivariate analysis. However, none of the other factors including FRS was found to be significantly associated with CR-POPF risk. A strong positive correlation was found between the CR-POPF and the incidence of delayed gastric emptying, post-pancreatectomy hemorrhage and increased length of hospital stay. Conclusion: Blumgart's technique is a safe technique of pancreatico-enteric anastomosis with low rates of CR-POPF. CR-POPF with this technique is independent of most of the preoperative and intraoperative factors. Therefore, this technique can be used for all types of the pancreas with consistently good results.

A novel oil-in-water drilling mud formulated with extracts from Indian mango seed oil

Drilling muds with less environmental impact are highly desired over conventional diesel-based mud systems,especially in light of the emerging strict environmental laws.In this article,a novel oil-in-water(O/W)emulsion drilling fluid formulated with a methyl ester extracted from Indian mango seed oil was evaluated.The effect of the weight percent of different constituents of the emulsion/suspension including the oil phase,bentonite,and polyanionic cellulose polymer on the rheology and the fluid loss was examined.The methyl ester oil phase/mud system displayed superior physical,chemical,rheological and filtration properties relative to the diesel and the mango seed oil.Eco-toxicity of the methyl ester and diesel(O/W)emulsion mud systems was assessed using the acute lethal concentration test.The Indian mango methyl ester(O/W)emulsion mud displayed much less impact on fish population.Flow characteristics collected from the flow model at 85°C suggested excellent shear thinning behavior of the Indian mango methyl ester(IMME)(O/W)emulsion mud.Moreover,the IMME(O/W)emulsion displayed strong pseudoplastic behavior,an attractive feature in a drilling mud,with increasing clay content and polymer concentration.The methyl ester mud was thermally stable over a wide range of the constituent concentrations.Furthermore,a particle size analysis revealed that engineered drilling muds targeting suspension of particles with certain size range can be formulated by changing the volume fraction of the methyl ester in the mud system.

Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population

AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse(CRP) in North Indian patients with inherent bulky and redundant colon. METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. RESULTS: Fifteen patients(9 female) with a median age of 50 years(range, 15-68) were included in the study. The median operative time was 200 min(range, 180-350 min) and the median post-operative stay was 4 d(range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo(range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17(range, 5-24) to 6(range, 0-23)(P < 0.001) and the fecal incontinence severity index score from 24(range, 0-53)to 2(range, 0-53)(P = 0.007). No de novo constipation or fecal incontinence was recorded during the followup. On personal conversation, all patients expressed satisfaction with the outcome of their treatment. CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.