The effect of mesh reinforcement of a stapled transection line on the rate of pancreatic occlusion failure after distal pancreatectomy: review of a single institution's experience

AbstractBackgroundPancreatic occlusion failure (POF) after distal pancreatectomy remains a common source of morbidity. Here, we review our experience with distal pancreatectomy and attempt to identify factors which influence POF rates.Patients and MethodsOne hundred sixty-nine distal pancreatectomies were performed between 2002 and 2007. Review of the computerized medical records and physician office records was performed for all patients. Univariate and multivariate analyses were performed to determine factors which might influence the incidence of POF. The data set was analysed for factors which might influence the pancreatic occlusion rate. Analysis included patient and disease characteristics including: age, gender, body mass index (BMI), diagnosis, consistency of the pancreas and history of pancreatitis, as well as intra-operative variables including: surgeon, absorbable mesh reinforcement and operative approach.ResultsPOF was the most common peri-operative complication. POF was identified in 32 out of 169 patients (19%). Transection technique (hand sewn, stapled, stapled with mesh) and procedure complexity were factors associated with differences in POF rates by both univariate and multivariate analyses. POF was identified in 7 out of 70 patients (10%) when an absorbable mesh was utilized, and 25 of 99 patients (25%) when mesh was not utilized (P < 0.02).DiscussionThese data suggest that a randomized controlled trial will be required to determine if mesh reinforcement reduces the rate and severity of POF after distal pancreatectomy

The influence of functional warm ischemia time on DCD Liver Transplant Recipients' Outcomes

Duration of functional warm ischemia (f-WIT) is thought to have a causal effect on outcomes in controlled donation after circulatory death (DCD) liver transplantation (LT).status: publishe

Defining Benchmarks in Liver Transplantation A Multicenter Outcome Analysis Determining Best Achievable Results

: This multicentric study of 17 high-volume centers presents 12 benchmark values for liver transplantation. Those values, mostly targeting markers of morbidity, were gathered from 2024 "low risk" cases, and may serve as reference to assess outcome of single or any groups of patients. OBJECTIVE: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. BACKGROUND: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. METHODS: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. RESULTS: Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.status: publishe