E. Huguet

Laparoscopic adrenalectomy: Auditing the 10 year experience of a single centre

BACKGROUNDnLaparoscopic adrenalectomy (LA) is the gold standard for benign adrenal resection, and has been performed at our centre since 2000. We present a retrospective audit of our ten-year experience, and discuss the learning curve.nnnMETHODSnCreating a retrospective database, clinical and outcome data were collected for all resections performed over a ten-year period (2000-2010). Patients were chronologically divided into an early (first 40 cases) and late (subsequent cases) group to provide an insight into the learning curve.nnnRESULTSnOver this period, 134 laparoscopic resections were performed, predominantly for benign adenomas (80.3%), with 48% of patients having primary hyperaldosteronism. There was almost equal sex distribution and mean age was 50.2 years, with a median BMI of 28.2. The mean operating time for left and right procedures were 127 and 124xa0min respectively, with 56.7% of resections being left sided. Our rate of conversion to open was 3.9%. Median length of stay was 4 days post-operatively. There was no mortality and 8.7% patients experienced a surgical complication. Analysis of the grouped data demonstrated a statistically significant reduction in open conversion rate (pxa0=xa00.017) and operative time (pxa0=xa00.011) in the late group. Among the two groups there was no statistically significant difference in the length of stay and surgical complication rate. All results were comparable to published series in the literature.nnnCONCLUSIONnLA has proven to be a safe procedure with a low complication rate at our centre. Our data provide evidence that operative time and conversion rate improves with experience.

Negative predictive value of drain amylase concentration for development of pancreatic fistula after pancreaticoduodenectomy

BACKGROUNDnPost-operative pancreatic fistula (POPF) is the major source of morbidity following pancreaticoduodenectomy. A predictive indicator would be highly advantageous. One potential marker is drain amylase concentration (DAC). However, its predictive value has not been fully established.nnnMETHODSn405 patients undergoing pancreaticoduodenectomy at our centre over a 10 year period were reviewed to determine the value of DAC as a predictive indicator for the development of POPF.nnnRESULTSnPOPF developed in 58 patients (14%). These patients suffered greater morbidity. Overall 30-day mortality was 1.5%. Male gender (OR: 5.1; pxa0=xa00.0082) and agexa0>xa070 (OR 2; pxa0=xa00.0372) were independent risk factors for POPF, whilst Type 2 diabetes (OR: 0.2321; pxa0=xa00.0090) and pancreatic ductal-adenocarcinoma (OR: 0.3721; pxa0=xa00.0039) decreased POPF risk. The DACs post-operatively were significantly higher in those developing POPF, but with significant overlap. ROC curves revealed optimal threshold values for differentiating POPF and non-POPF patients. A DAC°<°1400xa0U/ml on day 1 and <768xa0U/ml on day 2, although having a poor positive predictive value (32-44%), had a very strong negative predictive value (97-99%).nnnCONCLUSIONnOur data suggest that post-operative DAC below the determined optimal threshold values on day 1 and 2 following pancreaticoduodenectomy carries high negative predictive value for POPF development and identifies patients in whom early drain removal, and enhanced recovery may be considered, with simultaneous assessment of operative and clinical factors.

PTH-105 Salvage hepatectomy in failed portal vein embolisation

Introduction The traditional approach to induce liver hypertrophy of future liver remnant (FLR) is portal vein embolization (PVE). Portal vein ligation (PVL) was also used with successful outcome. Two stage hepatectomy with Association of Portal vein ligation and Partition of Liver (ALLPS)has been in practice recently. We analyse the cases which failed to achieve sufficient hypertrophy following PVE and has been salvaged by two staged hepatectomy. Method Our prospective database of 72 cases of PVE over 7 years were analysed and identified 4 cases that didn’t achieve sufficient hypertrophy and subsequently underwent two stage hepatectomy. Patient characteristics, volume increase, postoperative complications and outcomes were analysed. Results All 4 patients had extended right hepatectomy. Two patients had colorectal liver metastasis and the other two had hilar cholangiocarcinoma. The staged resections were carried out at an average of 14 days apart. Patient 1 had an FLR of 18%after PVE that increased to 38% after parenchymal transection (stage 1). Patient 2 had an FLR of 25% after PVE which increased to 39% after stage 1 resection. Patient 3 had FLR of 21% after PVE which increased to 34% after stage 1 resection. Patient 4 had FLR volume of 28% with background chronic liver fibrosis that increased to 36% after stage 1. All patients underwent a R0 resection. One patient had postoperative bile leak. There was no operative mortality. Conclusion Salvage resection of liver is an effective approach to patients who do not achieve sufficient FLR volume following PVE. Disclosure of interest None Declared.