One discussion this week included use of prosthetic graft reconstruction …
Reference: Chu CK, et al. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. Journal of the American College of Surgeons. 2010 Sep;211(3):316-324. doi: 10.1016/j.jamcollsurg.2010.04.005
Summary: Use of prosthetic grafts for reconstruction after portal vein (PV) resection during pancreaticoduodenectomy is controversial. This paper (by Emory authors) review 33 patients who underwent pancreaticoduodenectomy (PD) with vein resection and reconstruction using PTFE grafts between 1994 and 2009. Patient, operative, and outcomes variables were studied. Graft patency and survival were assessed using the Kaplan-Meier technique.
One discussion this week included early vs late drain removal in pancreatectomy.
References: Beane JD, et al. Variation of drain management after pancreatoduodenectomy: early versus delayed removal. Annals of Surgery. 2017 Oct. doi: 10.1097/SLA.0000000000002570
Deminski J, et al. Early removal of intraperitoneal drainage after pancreatoduodenectomy in patients without postoperative fistula at POD3: results of a randomized clinical trial. Journal of Visceral Surgery. 2019 Jan 31. pii: S1878-7886(18)30084-5. doi: 10.1016/j.jviscsurg.2018.06.006
Summary: Early drain removal after pancreatoduodenectomy, when guided by postoperative day (POD) 1 drain fluid amylase (DFA-1), is associated with reduced rates of clinically relevant postoperative pancreatic fistula (CR-POPF).
One discussion this week involved the use of prophylactic flomax in preventing postoperatuve urinary retention (POUR).
Reference: Ghuman A, et al. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. American Journal of Surgery. 2018 May;215(5):973-979. doi: 10.1016/j.amjsurg.2018.01.015. Epub 2018 Feb 3.
Summary: With an increase in outpatient and fast-track surgical procedures, urethral catheterization is used less commonly thus increasing the likelihood of POUR. Urethral catheterization, a mainstay of initial management for patients with POUR, can
be associated with prolonged length of hospital stay and complications, such as urinary tract infections that may increase cost of care.