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Orti-Rodriguez R.J.,University of Cordoba, Spain | Rahman S.H.,Center for Surgery and Liver Transplantation
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2014

In pancreatic surgery, there is an increasing interest in the feasibility of minimal access techniques. Robotic surgery has improved some limitations of standard laparoscopy and it is expected as a promising access. We provide a comparative review between laparoscopic and robotic pancreaticoduodenectomies. Between 1996 and 2013, we found 284 patients in the laparoscopic group and 147 in the robotic. Operative time, morbidity, and mortality were similar for both the groups (425.94 min, 30.28%, 2.19% in the laparoscopic group and 415.88 min, 36.78%, and 2.72% for the robotic arm, respectively). The mean hospital stay, mean estimated blood loss, fistula, and conversion rates were 11.09 days, 172,93 mL, 13.02%, and 5.63% and 13.84 days, 346.44 mL, 27.69%, and 11.56% for the laparoscopic and robotic group, respectively (P<0.05). Laparoscopic pancreaticoduodenectomy may confer benefits over robotic pancreaticoduodenectomies, although it is expected that outcomes of both modalities are likely to improve with greater experience and better patient selection. © 2014 by Lippincott Williams and Wilkins. Source


Puri Y.,Center for Surgery and Liver Transplantation | Rahman S.H.,Center for Surgery and Liver Transplantation
Journal of the Pancreas | Year: 2011

Context: Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis and has received little attention in the surgical literature. Such complications can range from localized colonic pathology to widespread ischaemic pancolitis. Treatment options have historically been limited to resection of the affected segment. Case report: We describe the successful role of video assisted retroperitoneal pancreatic debridement in the management of two cases presenting with major gastrointestinal haemorrhage due to localised colonic ulceration on the background of acute necrotising pancreatitis. Conclusion: Video assisted retroperitoneal debridement should be considered early in the management of local colonic complications associated with severe acute necrotising pancreatitis. Source


Rahman S.H.,Center for Surgery and Liver Transplantation | John B.J.,Center for Surgery and Liver Transplantation
Hernia | Year: 2010

Background Single-incision laparoscopic surgery (SILS) is aimed at improving the cosmetic outcome following surgery. If the incision is made through the umbilicus, the surgery is almost 'scarless.' This is increasingly being used for laparoscopic cholecystectomy with good cosmetic results without compromising the safety of the operation. The challenge of this surgery lies in manipulating instruments within the limitations of the closely inserted ports. Methods We describe the first case of SILS hernia repair via the trans-abdominal pre-peritoneal approach (TAPP) in a 39-year-old male as a day-case procedure. Results The patient was discharged without any complications. Conclusions This novel surgical technique is feasible and improves cosmetic outcome without additional risk. The advantage of such an approach above and beyond cosmesis remains to be evaluated. © Springer-Verlag 2009. Source


Sahay S.J.,Center for Surgery and Liver Transplantation | Gonzalez H.D.,Center for Surgery and Liver Transplantation | Luong T.V.,Center for Surgery and Liver Transplantation | Rahman S.H.,Center for Surgery and Liver Transplantation
Journal of the Pancreas | Year: 2010

Context Chronic alcoholic pancreatitis is a debilitating disease that is often complicated by pseudotumoral changes of the pancreas, retroperitoneal fibrosis, and pancreatic cancer. Actinomycosis is an uncommon intra-abdominal infection and its association with chronic pancreatitis has been rarely reported. Case report We present a case of a patient with progressive long standing chronic pancreatitis who develops pseudo-tumoural changes and retroperitoneal fibrosis associated with actinomycosis. Conclusion This is a rare presentation of actinomycosis, posing a diagnostic challenge to the clinician, with important therapeutic implications. Source


John B.J.,Center for Surgery and Liver Transplantation | Naik P.,Center for Surgery and Liver Transplantation | Ironside A.,Royal Free Hospital | Davidson B.R.,Center for Surgery and Liver Transplantation | And 4 more authors.
HPB | Year: 2013

Introduction The presence of positive nodal disease (LND) and the number of lymph nodes involved (LNB) are known to be significant prognostic markers for resected adenocarcinoma of the pancreas. In addition, the ratio of the number of involved nodes to the number of nodes resected known as the lymph node ratio (LNR) is emerging as an important prognostic marker. The role of the resection margin (RM) as presently defined (R1 ≤ 1 mm) is unclear as results differ based on the dataset. The aim of this study was to assess the impact of nodal disease and a redefined RM on outcome. Material and methods Retrospective analysis of pancreatic head resections for adenocarcinomas from 2003-2009. The RM was re-analysed based on tumour clearance and categorized into: histopathological evidence of a tumour; ≤0.5 mm, ≤1 mm, ≤1.5 mm, or ≤2.0 mm of the actual surgical resection margin. The impact of histopathological variables on cancer-specific survival (CSS) and disease-free survival (DFS) was analysed. Results LND, LNB and LNR were independent prognostic markers for CSS (P = 0.048, 0.003, 0.016) but, did not influence DFS. A LNR < 0.143 was associated with a higher CSS [38.16 ± 4.69 versus 20.59 ± 2.20 months, P = 0.0042, hazard ratio (HR) 3.74 (95% confidence interval (CI) 1.52-9.23)]. An R1 RM was not associated with CSS or DFS on multivariate analysis, irrespective of the distance. LNB and LNR maintained independent significance irrespective of the size of the RM. Conclusion LNB and LNR are the only prognostic factors for CSS in patients with pancreatic head adenocarcinoma, but do not predict recurrence. Microscopic RMs does not seem to influence the outcome even when redefined. Further prospective studies are indicated to substantiate these findings. © 2013 International Hepato-Pancreato-Biliary Association. Source

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