E. Bardaxoglou

Who Benefits from Portal Vein Resection during Pancreaticoduodenectomy for Pancreatic Cancer

Abstract. Portal vein resection during pancreaticoduodenectomy has recently experienced renewed interest. We describe our results with this procedure over a 20-year period. Among 88 consecutive pancreatectomies for cancer of head of the pancreas, 14 included en bloc removal of the portal vein. There was no hospital mortality. Only 21% were found to have histologically confirmed cancer invasion, and the remainder had inflammatory adherence. Two-year survival was 15% compared to 34% for patients who did not have portal vein resection. There were no 5-year survivors. We discuss our results in light of other recent reports.

Diagnosis and Therapy for Ampullary Tumors: 63 Cases

Abstract. From 1970 to 1992 a total of 63 patients underwent operation for ampullary tumor: 40 pancreatoduodenectomies (PDs), 3 total PDs, 8 ampullectomies, and 12 bypass or exploratory laparotomies. The resectability rate was 68%. There were 9 benign tumors, 1 anaplastic tumor, and 53 adenocarcinomas. According to Martin’s classification, there were 7 stage I, 11 stage II, 14 stage III, and 21 stage IV tumors. All patients with stage I, II, and III tumors underwent resection. Patients with stage IV tumors had either resection (n = 11) or bypass (n = 10). The mean duration of hospital stay was 20.6 days. Operative mortality was 12.7% for the whole series and 7.5% after PD (2.5% for the last 10 years). Overall survival was 40% at 5 years (85% for stage I, 65% for stage II, 44% for stage III, and 8% for stage IV). Survival was better for stages I, II, and III after PD than after ampullectomy. For stage IV patients survival was 70% after PD versus 20% after bypass at 1 year and 25% versus 0% after 2 years. In our opinion, PD should be proposed even for benign lesions because two of our patients had to undergo repeat operation (PD) 4 and 22 years later, respectively, for stage IV disease. PD is our choice for all tumors of the ampulla.

Gastrointestinal surgical emergencies following kidney transplantation

This study reports major gastrointestinal complications in a group of 416 patients following kidney transplantation. Three hundred and ninety-nine patients received a cadaveric kidney while the other 17 received a living related organ. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, and cyclosporin. Perforations occurred in the colon (n=6), small bowel (n=4), duodenum (n=2), stomach (n=1), and esophagus (n=1). There were five cases of acute pancreatitis, four of upper gastrointestinal and two of lower intestinal hemorrhage, two of acute appendicitis, one of acute cholecystitis, one postoperative mesenteric infarction, and two small bowel obstructions. Fifty percent of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or episodes of acute rejection. Ten percent of the complications had an iatrogenic cause. Of the 31 patients affected, 10 (30%) died as a direct result of their gastrointestinal complication. This high mortality appears to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications can be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.

New Approach to Surgical Management of Early Esophageal Thoracic Perforation: Primary Suture Repair Reinforced with Absorbable Mesh and Fibrin Glue

Abstract Esophageal perforation is a life-threatening situation and represents a major therapeutic challenge. Results have improved in recent years particularly as a result of progress in antibiotic therapy and the use of total parenteral nutrition. Surgical management retains a predominant role, involving early primary closure and thoracic drainage. We have made an addition to the surgical management by applying an absorbable mesh and fibrin glue to the repaired site. Seven patients (ages 38–79 years) were treated as described. The mean interval from leak to surgery was 28 hours. Six patients had an uneventful postoperative course with a mean hospital stay of 34 days (range 26–45 days). In one case the technique failed and the patient required an exclusion-diversion procedure. All 7 patients recovered without mortality. We believe that this technique provides a real improvement for this precarious esophageal repair.

Total pancreatectomy and subtotal duodenopancreatectomy for the management of carcinoma of the head of the pancreas: an institutional experience and evolving trends.

This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Initially in 1973 total p

A simple method to control intractable bleeding after endoscopic sphincterotomy

A successful method for controlling intractable bleeding after endoscopic sphincterotomy is described. By passing a Fogarty catheter into the duodenum, balloon tamponade of the bleeding point is possible. By such a technique, major resective surgery can be avoided.

Intrahepatic Hematoma following Needle Biopsy of Liver Graft: Incidence and Management

Percutaneous liver biopsy is a frequently used technique to diagnose hepatic allograft dysfunction after liver transplantation. One hundred and twenty-four grafts were biopsied under ultrasound contro

Surgical Treatment of Chronic Pancreatitis: Indications and Results in 246 Consecutive Patients

From 1972 to 1986, 246 patients, with a large majority of alcoholics, were operated on for chronic pancreatitis. Mean age was 44.2 ± 23.4 years and the male/female sex ratio was 217/29. In 223, 22 and