Abstracts / Pancreatology 13 (2013) S2–S98
interrupted suture sequentially, which approximate jejunal serosa to pancreatic capsule, thus allowing invagination of pancreatic stump into jejunum. 2. Omental patch: A strip of omentum is prepared and patched surrounding P-J, isolating this anastomosis from free abdominal cavity, and especially important vessels. 3. Duodenojejunostomy (D-J): Before anastomosis, clamped duodenal resection margin is ﬁrst cauterized for hemostasis and sealing the wall into one layer. Then inner layer of anastomosis with running suture is placed, taking bites of the single layer on duodenal side and full thickness bites of bowel wall on jejunal side. Outer layer is performed with continuous Lembert sutures. 4. Intraluminal drainage: A nasogastric tube is deeply placed into the afferent limb through D-J, with its end near P-J, serving as an external drainage tube. Results: Our modiﬁcations confer advantages of technical convenience. With increased technical precision, better outcomes are guaranteed. Conclusion: Precise manipulations and good quality should always be emphasized in PPPD.
PI-91 Abstract id: 21. Is pancreaticogastrostomy a safe procedure? Deena Hadedeya, Saud Almuhammadi. King Faisal Specialist Hospital & Research Center-Jeddah, Saudi Arabia Introduction: Pancreaticoduodenectomy is treatment of choice for periampullary tumors. This procedure carry a signiﬁcant risk and morbidities. Most of them are related to pancreatic anastomotic failure. For that many techniques has been established to decrease the morbidity rate, pancreaticogastrostomy is one of those techniques. Aims: evaluate the pancreaticogastrostomy procedure after pancreaticoduodenectomy Patients & methods: Design: Retrospective review was done for all patient who diagnosed with periampullary tumor between 2008 to 2012. Setting: king Faisal Specialist Hospital & Research Center- Jeddah, Saudi Arabia. Outcome Measures: Indication for surgery, intra-operative and post operative variables, operative technique and post-operative complications. Results: In group of patient who underwent pancreaticogastrostomy (n¼20) including 10 males and 10 females, the mean age was 56.2 years. The histopathology post operatively showed 4 benign tumors and 16 malignant tumors, with mean size of tumor 3.39 cm in diameter. The median hospital stay was 10.8 days with median survival months were 13.05 months. The complications from pancreatecogastrostomy following pancreaticoduodenectomy has been calculated as following 5% of the patients developed biliary leak, 10% experienced delayed gastric emptying, 5% were having intra-abdominal collection, 15% were having wound infection, 5% developed wound dehiscence, 15% of the patients developed atelectasis, 5% diagnosed with DVT and 10% with PE, 10% of the patient were died due to intraoperative hemorrhage as a result of porta hepatis injury. No one of our patient developed pancreatic leak, acute pancreatitis nor cholingitis. Conclusion: Pancreaticogastrostomy is a safe procedure with a relatively low mortality and morbidity rate. It should be considered as a suitable choice after pancreaticoduodenectomy.
PI-92 Abstract id: 199. Pancreatic cancer: does irreversible electroporation improve the quality of life and the survival in local advanced pancreatic adenocarcinoma? Report of a pilot case Antonio Braucci, Antonello Niglio, Carlo Molino. Cardarelli Hospital, Naples, Italy Introduction: Current strategy for local advanced pancreatic adenocarcinoma (LAPC), based on chemotherapy and radiation therapy, shows
poor outcome. A novel form of tissue ablation has been proposed in the treatment of solid tumors with promising results: irreversible electroporation (IRE). The technique uses high voltage pulses applied to the target tissue to induce cells’ apoptosis. Aims: We aim to show the efﬁcacy and safety of IRE as a palliative treatment on clinical outcome of LAPC. Patients & methods: A 59-year-old caucasic man diagnosed in January 2012 with a stage III (T4N1M0) LAPC of the body-tail (60x30mm) encasing the superior mesenteric vessels and the small gastric curve underwent a 6 months neo-adjuvant gemcitabine-based chemotherapy and was planned for Whipple procedure. Since the tumor was still unresectable, US-guided IRE using the NanoKnife System by Angiodynamics has been performed. Results: Postoperative course was uneventful and the patient was discharged six days after the treatment. The follow up at one month, 3 and 6 months showed a CT-scan-documented reduction of the primitive mass (40x22mm VS 60x30mm). CA 19.9 levels’ trend showed also a decrease. After 15 months from the diagnosis the patient is still alive in a state of mental and physical wellbeing. Conclusion: IRE promises encouraging results in local control of LAPC. The technique has shown to improve both the overall survival and the quality of life compared with previous palliative strategies. Further studies are needed to elucidate the real advantages of this innovative technique and its future application even in the management of resectable pancreatic adenocarcinomas instead of conventional surgery.
PI-93 Abstract id: 145. Characteristics of patients with chronic pancreatitis and pancreatic cancer Snezana Lukic 1, Dragan Popovic 2, Aleksandra Sokic Milutinovic 2, Djordje Knezevic 3, Srbislav Knezevic 4, Biljana Milicic 5, Tomica Milosavljevic 2. 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Gastroenterology, Clinical Center of Serbia, Belgrade, Serbia 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Gastroenterology, Clinical Center of Serbia, Belgrade, Serbia 3 First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia, Serbia 4 Faculty of Medicine, University of Belgrade, Belgrade, Serbia First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia, Serbia 5 Institute for Medical Statistic and Informatics, School of Dentistry, University of Belgrade, Belgrade, Serbia, Serbia
Introduction: Chronic pancreatitis is a chronic inﬂammatory disease of the pancreas leading to exocrine and endocrine pancreatic insufﬁciency. Pancreatic cancer is a malignant neoplasm of the exocrine pancreas in which the mortality rate is almost equal incidence of disease. The disease is diagnosed at a late stage and the surgical treatment possible in only 10-15% of patients. Chronic pancreatitis and pancreatic cancer have complex and unclear aetiology and pathogenesis. Aims: The aim of this study was to determine which characteristics of patients- age, gender, fat intake, smoking, alcohol consumption have the greatest importance in the development of chronic pancreatitis and pancreatic cancer. Patients & methods: The study included 55 patients with chronic pancreatitis, 45 patients with pancreatic cancer and 70 healthy controls. Multivariate regression analysis was used to identify predictive risk factors for pancreatic diseases. Results: Results of our study showed that male, sex, older age, smoking, fatty diet were signiﬁcantly higher in patients with pancreatic cancer. Women have ﬁve times lower risk for the occurrence of chronic pancreatitis, and about four times lower risk for pancreatic cancer. With each year of life the risk of pancreatic cancer is increased by 5%. Smokers were under 3.5 times higher risk for pancreatic cancer. Conclusion: In conclusion, these results suggest that pancreatic cancer occurs more frequently in older males and smoking is predictive risk factor for pancreatic cancer.