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Conservative surgery for pancreatic neck transection

100%
Dahiya D., Singh Rana S., Kaman L., Behera A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 6
315-319
EN
Pancreas is the fourth solid organ injured in blunt abdominal trauma. Isolated pancreatic injury is present in less than 1% of patients. As it is associated with high morbidity and mortality, management is controversial. Isolated pancreatic trauma cases with pancreatic neck transection following blunt abdominal trauma were analyzed. All these patients were treated with immediate surgery involving lesser sac drainage and feeding jejunostomy only. Authors conclude that lesser sac drainage can be used as an alternative to distal pancreatectomy or pancreaticojejunostomy or pancreaticogastrostomy.
2
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Effect of perioperative glutamine administration on C-reactive protein and liver function tests in patients undergoing hepatic resection

88%
Richard V., Dahiya D., Kaman L., Raj P., Behera A.
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vol. 86
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issue 1
11-16
EN
Hepatic resections are commonly associated with high morbidity and mortality. Nutrition plays an important role in reducing postoperative complications besides improvement in intensive care and perioperative management. The aim of the study was to evaluate the role of glutamine as an immunonutrient in patients undergoing hepatic resection. Material and methods. The study included 22 patients who underwent hepatectomy. Patients were randomized into two equal groups wherein group A patients received perioperative glutamine whereas group B patients served as controls. Primary outcome measures were level of serum albumin, C‑reactive protein (CRP), liver function tests and absolute neutrophil counts in the postoperative period while secondary outcome included post operative complications. Results. Glutamine decreased the CRP response in liver resection in a statistically significant manner (p=0.028) on the fifth post operative day. This may signify that glutamine decreases the post operative inflammatory response associated with liver resection. Glutamine did not have any significant effect on liver function tests. Postoperative morbidity was less in patients who received glutamine. Conclusion. Glutamine successfully blunted the CRP response in patients who received glutamine postoperatively. Decrease in morbidity following glutamine administration is an attractive area of prospective research and requires further consideration involving larger patient groups.
3
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Duodenal Tuberculosis – A Rare Case Report and Review of Literature

76%
Dahiya D., Garg M., Kaman L., Rana S., Rao C., Behera A.
Polish Journal of Surgery
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2013
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vol. 85
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issue 8
464-466
EN
Extrapulmonary tuberculosis is rare and often difficult to diagnose infection. We report a case of duodenal tuberculosis, who presented with upper gastrointestinal symptoms. There was evidence of obstruction in the third part of duodenum (D3) on oesophagogastro endoscopy, barium meal follow through and CT scan of abdomen. On exploration there was thickening of D3 and D4 causing luminal obstruction. Resection of stricturous segment with end-to-side duodenojejunostomy was done. Biopsy of the diseased segment was tubercular. Antitubercular treatment was given to the patient for 6 months and he is doing well on follow up (1 year after surgery). Duodenal tuberculosis being the rarest form of intestinal tuberculosis poses great difficulty in diagnosis. High index of suspicion supported by radiological investigation, exploratory laparotomy and histopathological examination of the tissue can only lead to a definitive diagnosis of this rare condition. Treatment is both surgical which involves resection or by-pass for an obstructive lesion and medical which includes antitubercular therapy
4
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Internal stenting across the pancreaticojejunostomy and main pancreatic duct after pancreaticoduodenectomy

76%
Singh K., Kaman L., Tandup C., Raypattanaik N., Dahiya D., Behera A.
Polish Journal of Surgery
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2021
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vol. 93
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issue 3
40-47
EN
Background: Postoperative pancreatic fistula (POPF) is associated with high morbidity and mortality rates. Studies have reported internal stenting of the pancreaticojejunostomy (PJ) to reduce POPF, but it is still controversial. Aim: In this study, we compared the outcome of internal stenting across the PJ to reduce POPF following pancreaticoduodenectomy (PD) and described our technique of putting the internal stent across the PJ and in to the main pancreatic duct. Materials and methods: Fifty patients undergoing elective PD were included. Patients were divided into two groups in a randomized fashion; Group A (n = 25) without internal stenting across the PJ and Group B (n = 25) with internal stenting of the PJ. The primary endpoint was the occurrence of POPF. Results: Both groups were comparable in demographics, comorbidities, pathologies, pancreatic texture and pancreatic duct diameter. Out of 50 patients studied, a total of 23 (46.0%) patients developed postoperative pancreatic fistula. Ten (40%) in group A and 13 (52%) in group B (p = 0.156). Sixteen patients (32%) developed Grade A and 7 (14%) patients had Grade B postoperative pancreatic fistula. In group A, 6 patients developed grade A and 4 patients developed grade B postoperative pancreatic fistula. In group B, 10 patients developed grade A and 3 patients developed grade B postoperative pancreatic fistula. There was no Grade C fistula. All patients had satisfactory recovery after conservative management. Eight patients (16%) developed delayed gastric emptying [5 in group A and 3 in group B; p = 0.366]. Six patients developed a superficial surgical site infection (2 in group A and 4 in group B; p = 0.445). The length of hospital stay was comparable between the two groups. There was no mortality. Conclusion: Internal stenting of PJ does not decrease the rate of POPF after PD.
5
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Stentowanie wewnętrzne przez pankreatojejunostomię i główny przewód trzustkowy po pankreatoduodenektomii

76%
Singh K., Kaman L., Tandup C., Raypattanaik N., Dahiya D., Behera A.
Polish Journal of Surgery
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2021
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vol. 93
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issue 3
40-47
PL
Wprowadzenie: Pooperacyjna przetoka trzustkowa (POPF) wiąże się z wysoką zachorowalnością i śmiertelnością. Badania wykazały, że wewnętrzne stentowanie pankreatojejunostomii (PJ) może zmniejszyć POPF, ale metoda ta nadal budzi kontrowersje. Cel: W niniejszej pracy porównano wyniki zastosowania stentowania wewnętrznego przez PJ w celu zmniejszenia POPF po pankreatoduodenektomii (PD) i opisano technikę zakładania stentu wewnętrznego przez PJ do głównego przewodu trzustkowego. Materiały i metody: Do badania włączono 50 pacjentów poddanych elektywnej PD. Zrandomizowano ich do jednej z dwóch grup: Grupa A (n = 25) bez stentowania wewnętrznego przez PJ i Grupa B (n = 25) z wewnętrznym stentowaniem PJ. Pierwszorzędowym punktem końcowym było wystąpienie POPF. Wyniki: Obie grupy były porównywalne pod względem: danych demograficznych, chorób współistniejących, patologii, struktury trzustki i średnicy przewodu trzustkowego. Spośród 50 badanych pacjentów, u 23 (46,0%) rozwinęła się POPF – u 10 (40%) w grupie A i 13 (52%) w grupie B (p = 0,156). U 13 chorych (32%) rozwinęła się przetoka pooperacyjna trzustki stopnia A, a u 7 (14%) – stopnia B. W grupie A u 6 chorych rozwinęła się przetoka pooperacyjna stopnia A, a u 4 stopnia B. W grupie B u 10 chorych rozwinęła się przetoka pooperacyjna trzustki stopnia A, a u 3 stopnia B. Nie stwierdzono przetoki stopnia C. U wszystkich osób uzyskano zadowalający powrót do zdrowia po leczeniu zachowawczym. U 8 pacjentów (16%) wystąpiło opóźnienie opróżniania żołądka (5 w grupie A i 3 w grupie B; p = 0,366). U 6 pacjentów pojawiło się powierzchowne zakażenie miejsca operowanego (2 w grupie A i 4 w grupie B; p = 0,445). Długość pobytu w szpitalu była porównywalna w obu grupach. Nie odnotowano zgonów. Wnioski: Wewnętrzne stentowanie PJ nie zmniejsza częstości występowania POPF po PD.
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