Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Jan 2009
Comparative StudyImpact of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for adenocarcinoma of the body or tail of the pancreas.
Few patients with pancreatic body or tail carcinoma are candidates for surgical resection, and the efficacy of postoperative adjuvant chemotherapy for patients with pancreatic body or tail carcinoma has not been elucidated. The aim of this study was to determine the effect of adjuvant gemcitabine and S-1 therapy for patients with adenocarcinoma of the body or tail of the pancreas who had undergone surgical resection by distal pancreatectomy. ⋯ Postoperative adjuvant gemcitabine plus S-1 chemotherapy may improve survival after surgical resection for pancreatic body or tail carcinoma.
-
J. Gastrointest. Surg. · Dec 2008
Looking beyond age and co-morbidities as predictors of outcomes in paraesophageal hernia repair.
Paraesophageal hernia (PEH) repair is a technically challenging operation. These patients are typically older and have more co-morbidities than patients undergoing anti-reflux operations for gastroesophageal reflux disease (GERD), and these factors are usually cited as the reason for worse outcomes for PEH patients. Clinically, it would be useful to identify potentially modifiable variables leading to improved outcomes. ⋯ While PEH patients have worse post-operative outcomes than GERD patients, we note that differences in mortality are explained by pulmonary complications, VTE, and hemorrhage. The impact of hemorrhagic complications on this group underscores the importance of careful dissection. Additionally, age and co-morbidities alone should not preclude a patient from PEH repair; rather, attention should be focused on peri-operative optimization of pulmonary status and prophylaxis of thromboembolic events.
-
J. Gastrointest. Surg. · Dec 2008
Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines?
Current guidelines suggest that cholecystectomy be performed within 2 weeks after discharge following an episode of biliary pancreatitis. We hypothesized that a high incidence of gallstone-related events is present within 2 weeks after discharge prior to cholecystectomy. ⋯ Current guidelines suggesting the appropriateness of waiting up to 2 weeks for cholecystectomy for biliary pancreatitis may place patients at unacceptably high risk for recurrence. Endoscopic sphincterotomy does not eliminate the risk of gallstone-related events.
-
J. Gastrointest. Surg. · Dec 2008
Case ReportsRapunzel syndrome complicated with gastric perforation diagnosed on operation table.
Rapunzel syndrome is a variety of trichobezoar with the main body in the stomach and the tail extending into the small or large bowel. Twenty-seven cases of Rapunzel syndrome have been reported in the literature so far. This particular case of Rapunzel syndrome was on table diagnosis in a case of gastric perforation. The bezoar was removed and the patient was given psychiatric consultation.