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Marc G Besselink - One of the best experts on this subject based on the ideXlab platform.
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timing of Surgical Intervention in necrotizing pancreatitis
Archives of Surgery, 2007Co-Authors: Marc G Besselink, Thomas J Verwer, Ernst J P Schoenmaeckers, Erik Buskens, Ben U Ridwan, Maarten R Visser, Vincent B Nieuwenhuijs, Hein G GooszenAbstract:OBJECTIVE: To determine the effect of timing of Surgical Intervention for necrotizing pancreatitis. DESIGN: Retrospective study of 53 patients and a systematic review. SETTING: A tertiary referral center. Main Outcome Measure Mortality. RESULTS: Median timing of the Intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (P <.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P = .02). The 30-day group also had the lowest mortality (8% vs 75% in the 1 to 14-days group and 45% in the 15 to 29-days group, P <.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22% vs 47%, P = .09). We also reviewed 11 studies with a total of 1136 patients. Median Surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of Surgical Intervention was 26 days (range, 3-31), and median mortality was 25% (range, 6%-56%). We observed a significant correlation between timing of Intervention and mortality (R = - 0.603; 95% confidence interval, - 2.10 to - 0.02; P = .05). CONCLUSION: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibiotic-resistant organisms
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Surgical Intervention in patients with necrotizing pancreatitis
British Journal of Surgery, 2006Co-Authors: Marc G Besselink, Marja A Boermeester, M T De Bruijn, J P Rutten, Hendrik S Hofker, H G GooszenAbstract:BACKGROUND: This study evaluated the various Surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. METHODS: This retrospective study included all 106 consecutive patients who had Surgical treatment for INP in the period 2000-2003 in one of eight Dutch university medical centres including three teaching hospitals. Surgical approaches included an open abdomen strategy, laparotomy with continuous postoperative lavage, minimally invasive procedures or laparotomy with primary abdominal closure. The National Hospital Registration System was searched to identify patients with acute pancreatitis who were admitted to the 90 Dutch hospitals that did not participate in the present study. RESULTS: The overall mortality rate was 34.0 per cent, 70 per cent (16 of 23) for the open abdomen strategy, 25 per cent (13 of 53) for continuous peritoneal lavage, 11 per cent (two of 18) for minimally invasive procedures and 42 per cent (five of 12) for primary abdominal closure (P < 0.001). During the study interval, 44 (12.2 per cent) of 362 patients with acute pancreatitis who were likely to require Surgical Intervention had been referred to university medical centres. CONCLUSION: Laparotomy with continuous postoperative lavage is the Surgical strategy most often used in the Netherlands. The results of the open abdomen strategy are poor whereas a minimally invasive approach seems promising
Hein G Gooszen - One of the best experts on this subject based on the ideXlab platform.
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endoscopic or Surgical Intervention for painful obstructive chronic pancreatitis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Johanna M Pahlplatz, Wiliam H Nealon, Harry Van Goor, Hein G Gooszen, Marja A BoermeesterAbstract:BACKGROUND: Endoscopy and surgery are the treatment modalities of choice for patients with chronic pancreatitis and dilated pancreatic duct (obstructive chronic pancreatitis). Physicians face, without clear consensus, the choice between endoscopy or surgery for this group of patients. OBJECTIVES: To assess and compare the effects and complications of Surgical and endoscopic Interventions in the management of pain for obstructive chronic pancreatitis. SEARCH METHODS: We searched the following databases in The Cochrane Library: CENTRAL (2014, Issue 2), the Cochrane Database of Systematic Reviews (2014, Issue 2), and DARE (2014, Issue 2). We also searched the following databases up to 25 March 2014: MEDLINE (from 1950), Embase (from 1980), and the Conference Proceedings Citation Index - Science (CPCI-S) (from 1990). We performed a cross-reference search. Two review authors independently performed the selection of trials. SELECTION CRITERIA: All randomised controlled trials (RCTs) of endoscopic or Surgical Interventions in obstructive chronic pancreatitis. We included trials comparing endoscopic versus Surgical Interventions as well as trials comparing either endoscopic or Surgical Interventions to conservative treatment (i.e. non-invasive treatment modalities). We included relevant trials irrespective of blinding, the number of participants randomised, and the language of the article. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. Two authors independently extracted data from the articles. We evaluated the methodological quality of the included trials and requested additional information from study authors in the case of missing data. MAIN RESULTS: We identified three eligible trials. Two trials compared endoscopic Intervention with Surgical Intervention and included a total of 111 participants: 55 in the endoscopic group and 56 in the Surgical group. Compared with the endoscopic group, the Surgical group had a higher proportion of participants with pain relief, both at middle/long-term follow-up (two to five years: risk ratio (RR) 1.62, 95% confidence interval (CI) 1.22 to 2.15) and long-term follow-up (>/= five years, RR 1.56, 95% CI 1.18 to 2.05). Surgical Intervention resulted in improved quality of life and improved preservation of exocrine pancreatic function at middle/long-term follow-up (two to five years), but not at long-term follow-up (>/= 5 years). No differences were found in terms of major post-Interventional complications or mortality, although the number of participants did not allow for this to be reliably evaluated. One trial, including 32 participants, compared Surgical Intervention with conservative treatment: 17 in the Surgical group and 15 in the conservative group. The trial showed that Surgical Intervention resulted in a higher percentage of participants with pain relief and better preservation of pancreatic function. The trial had methodological limitations, and the number of participants was relatively small. AUTHORS' CONCLUSIONS: For patients with obstructive chronic pancreatitis and dilated pancreatic duct, this review shows that surgery is superior to endoscopy in terms of pain relief. Morbidity and mortality seem not to differ between the two Intervention modalities, but the small trials identified do not provide sufficient power to detect the small differences expected in this outcome.Regarding the comparison of Surgical Intervention versus conservative treatment, this review has shown that Surgical Intervention in an early stage of chronic pancreatitis is a promising approach in terms of pain relief and pancreatic function. Other trials need to confirm these results because of the methodological limitations and limited number of participants assessed in the present evidence.
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timing of Surgical Intervention in necrotizing pancreatitis
Archives of Surgery, 2007Co-Authors: Marc G Besselink, Thomas J Verwer, Ernst J P Schoenmaeckers, Erik Buskens, Ben U Ridwan, Maarten R Visser, Vincent B Nieuwenhuijs, Hein G GooszenAbstract:OBJECTIVE: To determine the effect of timing of Surgical Intervention for necrotizing pancreatitis. DESIGN: Retrospective study of 53 patients and a systematic review. SETTING: A tertiary referral center. Main Outcome Measure Mortality. RESULTS: Median timing of the Intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (P <.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P = .02). The 30-day group also had the lowest mortality (8% vs 75% in the 1 to 14-days group and 45% in the 15 to 29-days group, P <.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22% vs 47%, P = .09). We also reviewed 11 studies with a total of 1136 patients. Median Surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of Surgical Intervention was 26 days (range, 3-31), and median mortality was 25% (range, 6%-56%). We observed a significant correlation between timing of Intervention and mortality (R = - 0.603; 95% confidence interval, - 2.10 to - 0.02; P = .05). CONCLUSION: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibiotic-resistant organisms
Marja A Boermeester - One of the best experts on this subject based on the ideXlab platform.
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endoscopic or Surgical Intervention for painful obstructive chronic pancreatitis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Johanna M Pahlplatz, Wiliam H Nealon, Harry Van Goor, Hein G Gooszen, Marja A BoermeesterAbstract:BACKGROUND: Endoscopy and surgery are the treatment modalities of choice for patients with chronic pancreatitis and dilated pancreatic duct (obstructive chronic pancreatitis). Physicians face, without clear consensus, the choice between endoscopy or surgery for this group of patients. OBJECTIVES: To assess and compare the effects and complications of Surgical and endoscopic Interventions in the management of pain for obstructive chronic pancreatitis. SEARCH METHODS: We searched the following databases in The Cochrane Library: CENTRAL (2014, Issue 2), the Cochrane Database of Systematic Reviews (2014, Issue 2), and DARE (2014, Issue 2). We also searched the following databases up to 25 March 2014: MEDLINE (from 1950), Embase (from 1980), and the Conference Proceedings Citation Index - Science (CPCI-S) (from 1990). We performed a cross-reference search. Two review authors independently performed the selection of trials. SELECTION CRITERIA: All randomised controlled trials (RCTs) of endoscopic or Surgical Interventions in obstructive chronic pancreatitis. We included trials comparing endoscopic versus Surgical Interventions as well as trials comparing either endoscopic or Surgical Interventions to conservative treatment (i.e. non-invasive treatment modalities). We included relevant trials irrespective of blinding, the number of participants randomised, and the language of the article. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. Two authors independently extracted data from the articles. We evaluated the methodological quality of the included trials and requested additional information from study authors in the case of missing data. MAIN RESULTS: We identified three eligible trials. Two trials compared endoscopic Intervention with Surgical Intervention and included a total of 111 participants: 55 in the endoscopic group and 56 in the Surgical group. Compared with the endoscopic group, the Surgical group had a higher proportion of participants with pain relief, both at middle/long-term follow-up (two to five years: risk ratio (RR) 1.62, 95% confidence interval (CI) 1.22 to 2.15) and long-term follow-up (>/= five years, RR 1.56, 95% CI 1.18 to 2.05). Surgical Intervention resulted in improved quality of life and improved preservation of exocrine pancreatic function at middle/long-term follow-up (two to five years), but not at long-term follow-up (>/= 5 years). No differences were found in terms of major post-Interventional complications or mortality, although the number of participants did not allow for this to be reliably evaluated. One trial, including 32 participants, compared Surgical Intervention with conservative treatment: 17 in the Surgical group and 15 in the conservative group. The trial showed that Surgical Intervention resulted in a higher percentage of participants with pain relief and better preservation of pancreatic function. The trial had methodological limitations, and the number of participants was relatively small. AUTHORS' CONCLUSIONS: For patients with obstructive chronic pancreatitis and dilated pancreatic duct, this review shows that surgery is superior to endoscopy in terms of pain relief. Morbidity and mortality seem not to differ between the two Intervention modalities, but the small trials identified do not provide sufficient power to detect the small differences expected in this outcome.Regarding the comparison of Surgical Intervention versus conservative treatment, this review has shown that Surgical Intervention in an early stage of chronic pancreatitis is a promising approach in terms of pain relief and pancreatic function. Other trials need to confirm these results because of the methodological limitations and limited number of participants assessed in the present evidence.
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Surgical Intervention in patients with necrotizing pancreatitis
British Journal of Surgery, 2006Co-Authors: Marc G Besselink, Marja A Boermeester, M T De Bruijn, J P Rutten, Hendrik S Hofker, H G GooszenAbstract:BACKGROUND: This study evaluated the various Surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. METHODS: This retrospective study included all 106 consecutive patients who had Surgical treatment for INP in the period 2000-2003 in one of eight Dutch university medical centres including three teaching hospitals. Surgical approaches included an open abdomen strategy, laparotomy with continuous postoperative lavage, minimally invasive procedures or laparotomy with primary abdominal closure. The National Hospital Registration System was searched to identify patients with acute pancreatitis who were admitted to the 90 Dutch hospitals that did not participate in the present study. RESULTS: The overall mortality rate was 34.0 per cent, 70 per cent (16 of 23) for the open abdomen strategy, 25 per cent (13 of 53) for continuous peritoneal lavage, 11 per cent (two of 18) for minimally invasive procedures and 42 per cent (five of 12) for primary abdominal closure (P < 0.001). During the study interval, 44 (12.2 per cent) of 362 patients with acute pancreatitis who were likely to require Surgical Intervention had been referred to university medical centres. CONCLUSION: Laparotomy with continuous postoperative lavage is the Surgical strategy most often used in the Netherlands. The results of the open abdomen strategy are poor whereas a minimally invasive approach seems promising
Vikram D Durairaj - One of the best experts on this subject based on the ideXlab platform.
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predicting the need for Surgical Intervention in pediatric orbital cellulitis
American Journal of Ophthalmology, 2014Co-Authors: Jesse M Smith, Emily M Bratton, Peter E Dewitt, Brett W Davies, Eric M Hink, Vikram D DurairajAbstract:Purpose To investigate the predictive value of the complete ophthalmic examination at first presentation in foreseeing the need for surgery in patients with pediatric orbital cellulitis. Design Retrospective observational case series. Methods We reviewed 136 cases of radiographically confirmed orbital cellulitis between 2004 and 2012 at Children's Hospital Colorado. The presenting ophthalmic examinations, imaging results, medical and Surgical Interventions, and clinical complications were recorded. The main outcome measures were ophthalmic examinations on presentation, medical or Surgical Interventions, and complications. Results The median age was 6.5 years. Of the patients, 56 (41%) underwent Surgical Intervention, and 80 patients (59%) were managed medically. Patients requiring surgery had higher rates of extraocular motility (EOM) restriction (78.6% vs 38.8% P P P P Conclusions In pediatric orbital cellulitis, the likelihood of Surgical Intervention can be estimated accurately based on the ophthalmic examination on initial presentation to the hospital. Risk factors for surgery include age older than 9 years, proptosis, EOM restriction, and elevated IOP. These factors may be used to identify patients at high risk for failure of medical management early in the clinical course.
Shengjean Huang - One of the best experts on this subject based on the ideXlab platform.
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decompressive craniectomy as the primary Surgical Intervention for hemorrhagic contusion
Journal of Neurotrauma, 2008Co-Authors: Abel Pohao Huang, Yong Kwang Tu, Yihsin Tsai, Yuanshen Chen, Weichen Hong, Chicheng Yang, Ichang Su, Shehao Huang, Shengjean HuangAbstract:Abstract The standard Surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary Surgical Intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm3 in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary Surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of s...
