The role of magnetic resonance imaging and magnetic resonance sialography in the evaluation of salivary sialolithiasis : radiologic-endoscopic correlation

Purpose: To evaluate the role of magnetic resonance imaging (MRI) and MR sialography in salivary gland calculi in correlation with sialendoscopy. Material and methods: In this prospective study, pre-therapeutic MRI was performed for patients with clinically suspected sialolithiasis. In addition, sialendoscopy with or without surgery was performed. The detectability, number, size, and location of calculi (distance of obstruction from the ostium and masseter line) and the condition of the main duct at MRI were reported. Agreement between the 2 readers was confirmed for all MRI findings. Data regarding the detectability, number, and size of calculi were correlated with endoscopy. Results: There was excellent agreement between the 2 readers regarding the detection and number of calculi at MR sialography (κ = 1, p < 0.001). As regards MRI measurements, excellent interclass correlation was found between the 2 readers regarding size of calculi, distance of calculi from the ostium, and distance from the masseter line (κ = 0.98, 0.98, 0.97, respectively; p < 0.001). In correlation with sialendoscopy, MRI was false negative in 1 patient, and it missed 1 calculus in 3 patients with multiple calculi. There was no statistically significant difference between the size of calculi detected by MRI and true size of calculi retrieved by sialendoscopy. Conclusion: MR sialography is an accurate modality for diagnosis of the presence, size, and location of sialolithiasis and offers accurate ductal mapping for sialendoscopists

Surgical outcome and survival analysis of pancreaticogastrostomy after pancreaticoduodenectomy: A prospective study in a single institution

Background: The definitive reconstructive technique of the pancreatic stump after pancreaticoduodenectomy (PD) differs among centers. Purpose: The purpose of this study was to evaluate the surgical outcome of stented pancreaticogastrostomy (PG) and the long-term survival after PD in a single center. Patients and Methods: A prospective study of stented PG was performed on 152 patients by the same surgical team over a 7-year period from January 2010 to January 2017. In the early postoperative period, patients were examined for morbidity and mortality related to the procedure. After that, patients were followed up for long-term survival. Results: There were 88 men (57.9%) and 64 women (42.1%); with a mean age of 62.6 (35-87) years. Early postoperative complications occurred in 47 patients (30.9%) including five patients with the pancreatic leak. The survival rate at the end of 1 year, 3 and five years were 80%, 58%, and 42% respectively. Univariate and multivariate analysis revealed that longer survival was found in patients with lower tumor grades and stages, CA 19.9 level less than 100 ng/ml, negative R status and in patients not receiving chemotherapy. Conclusion: The present technique with its low morbidity rate approaches the parameters of an ideal pancreatic anastomotic technique after PD. Factors associated with better survival should be considered for the sake of obtaining the best prognosis. [Arch Clin Exp Surg 2018; 7(4.000): 133-146