Abstract:
OBJECTIVE:To document the decreased incidence of surgical complications after pancreas transplantation in recent times. SUMMARY BACKGROUND DATA:Compared with other abdominal transplants, pancreas transplants have historically had the highest incidence of surgical complications. However, over the past few years, the authors have noted a significant decrease in the incidence of surgical complications. METHODS:The authors studied the incidence of early (<3 months after transplant) surgical complications (e.g., relaparotomy, thrombosis, infections, leaks) after 580 pancreas transplants performed during a 12-year period. Patients were analyzed and compared in two time groups: era 1 (June 1, 1985, to April 30, 1994, n = 367) and era 2 (May 1, 1994, to June 30, 1997, n = 213). RESULTS:Overall, surgical complications were significantly reduced in era 2 compared with era 1. The relaparotomy rate decreased from 32.4% in era 1 to 18.8% in era 2. Significant risk factors for early relaparotomy were donor age older than 40 years and recipient obesity. Recipients with relaparotomy had significantly lower graft survival rates than those without relaparotomy, but patient survival rates were not significantly different. A major factor contributing to the lower relaparotomy rate in era 2 was a significant decrease in the incidence of graft thrombosis; the authors believe this lower incidence is due to the routine use of postoperative low-dose intravenous heparin and acetylsalicylic acid. The incidence of bleeding requiring relaparotomy did not differ between the two eras. Older donor age was the most significant risk factor for graft thrombosis. The incidence of intraabdominal infections significantly decreased between the two eras; this decrease may be due to improved prophylaxis regimens in the first postoperative week. CONCLUSIONS:Although a retrospective study has its limits, the results of this study, the largest single-center experience to date, show a significant decrease in the surgical risk associated with pancreas transplants. Reasons for this decrease are identification of donor and recipient risk factors, better prophylaxis regimens, refinements in surgical technique, and improved immunosuppressive regimens. These improved results suggest that more widespread application of pancreas transplantation is warranted.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Humar A,Kandaswamy R,Granger D,Gruessner RW,Gruessner AC,Sutherland DEdoi
10.1097/00000658-200002000-00017subject
Has Abstractpub_date
2000-02-01 00:00:00pages
269-75issue
2eissn
0003-4932issn
1528-1140journal_volume
231pub_type
杂志文章abstract::A review of the English literature reveals a total of 1,337 patients with choledochal cysts. Improved diagnostic techniques to visualize the biliary system are demonstrating an increasing number of unsuspected choledochal cysts in adult patients. Either choledochal cysts remain clinically silent until adulthood or may...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198105000-00018
更新日期:1981-05-01 00:00:00
abstract:OBJECTIVE:To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery. SUMMARY BACKGROUND DATA:Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, A...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.sla.0000114219.71899.13
更新日期:2004-03-01 00:00:00
abstract::Previous studies have demonstrated that Na(+)-dependent brush border glutamine transport is diminished in septic patients. To examine the potential regulation of this decreased transport by endotoxin, cytokines, or glucocorticoids, the human intestinal Caco-2 cell line was studied in vitro. Na(+)-dependent glutamine t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199205000-00017
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to analyze the health care costs and savings associated with quality improvement (QI) interventions initiated and implemented utilizing NSQIP. BACKGROUND:Five acute care facilities of Alberta Health Services (AHS) adopted NSQIP in 2015 for a pilot project. METHODS:The cost-savings ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002708
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To characterize the scope and magnitude of practice variation associated with the diagnosis and treatment of appendicitis at freestanding children's hospitals. BACKGROUND:Variation in care has been associated with poor outcomes and is believed to be a key driver of excess health care spending. METHODS:Retro...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000246
更新日期:2014-06-01 00:00:00
abstract::Although survival from primary breast cancer has improved with earlier diagnosis and treatment, the management of the opposite breast is still in question. The risk factors for bilaterality are known, and preoperative mammography is occasionally helpful, but identification of early second breast cancer is very limited...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198506000-00001
更新日期:1985-06-01 00:00:00
abstract::The aim of this study was to define the post-traumatic changes in body fluid compartments and to evaluate the effect of plasma colloid osmotic pressure (COP) on the partitioning of body fluid between these compartments. Forty-two measurements of plasma volume (green dye), extracellular volume (bromine), and total body...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198909000-00015
更新日期:1989-09-01 00:00:00
abstract:OBJECTIVE:This article outlines the formation of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) and describes its objectives, governance, functioning and challenges. BACKGROUND:A nationwide audit of surgical mortality provides an overview of the leading causes of death in patients who require surg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000581
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of inhalation of aerosolized opsonized dead Escherichia coli on inflammatory pulmonary neutrophil (PMN) apoptosis, lung injury, and survival in a PMN-mediated lung injury model in vivo. SUMMARY BACKGROUND DATA:Neutrophils that have transmigrated into an inflammatory focus display incre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200202000-00018
更新日期:2002-02-01 00:00:00
abstract::A new approach for preventing and treating sepsis due to central venous catheter (CVC) has been devised at the Istituto Nazionale Tumori of Milan. A prospective protocol has been developed that includes the weekly exchange of the CVC via a guidewire as well as its exchange when a CVC-related sepsis is suspected. Growt...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-198307000-00009
更新日期:1983-07-01 00:00:00
abstract::The role of the antrum on vagally mediated pancreatic secretion was studied in 8 conscious dogs prepared with chronic pancreatic and gastric fistulae. After completion of control studies 6 were subjected to antrectomy and 2 to antroneurolysis (to interrupt submucosal nerve connections); secretory studies were repeated...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197603000-00005
更新日期:1976-03-01 00:00:00
abstract:OBJECTIVE:Currently single-incision laparoscopic appendectomy (SIL-A) has become an option for treating appendicitis. The aim of this study was to evaluate the safety and feasibility of SIL-A compared with conventional laparoscopic appendectomy (CL-A) on a large experimental cohort. BACKGROUND:Several studies had repo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001064
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To evaluate recent surgical strategy for hilar cholangiocarcinoma (HC) of the left-side predominance. BACKGROUND:When employing left hemihepatectomy (LH) for HC, vasculobiliary anatomy of the right liver often makes it difficult to achieve a tumor-free margin of the right posterior sectional bile duct (RPSBD...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000584
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to identify determinants of disease recurrence after potentially curative resection of colorectal cancer. SUMMARY BACKGROUND DATA:The identification of patients at increased risk of disease recurrence is currently based on pathological factors. Recently, there has been consider...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31821fd469
更新日期:2011-07-01 00:00:00
abstract::Ileovesical and ileosigmoid fistulae were found to coexist in 22 patients with Crohn's ileocolitis. Persistent or recurrent urinary tract infection was a complaint in all cases, and 11 patients reported pneumaturia and/or fecaluria. Thus, bladder involvement was either suspected or clinically apparent in each patient....
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198801000-00010
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:Our study aims to provide a paradigm when it is ethical to perform cardiopulmonary resuscitation (CPR) on patients during the COVID-19 pandemic. SUMMARY BACKGROUND DATA:Hospitals around the nation are enacting systems to limit CPR in caring for COVID+ patients for a variety of legitimate reasons and based on...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004318
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE). BACKGROUND:Although obesity is an established risk factor for morbidity and mortality, the minimum amount of weight loss to have a meaningful impact on cardiovas...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004369
更新日期:2020-10-01 00:00:00
abstract::One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198504000-00014
更新日期:1985-04-01 00:00:00
abstract:OBJECTIVE:This study evaluates surgical procedures for Crohn's colitis. The risk of recurrence and how it interacts with future avoidance of permanent stoma and quality of life (QoL) is studied. BACKGROUND:Segmental and subtotal colectomy are widely used surgical options in isolated Crohn's colitis. It is not clear wh...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318212b1a4
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:To determine the accuracy of fine-needle aspiration (FNA) and vacuum-assisted core biopsy (VACB) in assessing the presence of residual cancer in the breast after neoadjuvant systemic therapy (NST). SUMMARY BACKGROUND DATA:Pathologic complete response (pCR) rates after NST have improved dramatically, suggesti...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000002313
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To assess the safety and efficacy of the ultrasonic dissection (UC) compared with standard electrosurgery (ES) in laparoscopic colorectal surgery. BACKGROUND DATA:High-frequency ultrasound energy was introduced in laparoscopic surgery to improve dissection and coagulation. Very limited data have been publish...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000189607.38763.c5
更新日期:2005-12-01 00:00:00
abstract:OBJECTIVE:To investigate potential impacts of restructuring general surgery training on colorectal (CR) surgery recruitment and expertise. SUMMARY BACKGROUND DATA:In response to the American Surgical Association Blue Ribbon Committee report on surgical education (2004), the American Board of Colon and Rectal Surgery, ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ad64f1
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of preoperative transarterial chemoembolization (TACE) for resectable large hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA:Resection of HCC is potentially curative, but local recurrence is very common. There is currently no effective neoadjuvant or adjuvant therapy. METHODS:F...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181961c16
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To compare outcomes for patients with hepatocellular carcinoma (HCC) treated with either liver resection or transplantation. METHODS:A retrospective, single-institution analysis of 413 HCC patients from 1999 to 2009. RESULTS:A total of 413 patients with HCC underwent surgical resection (n = 106) and transpl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31822ca66f
更新日期:2011-09-01 00:00:00
abstract:OBJECTIVE:Using a prospective randomized study to assess postoperative morbidity and pancreatic function after pancreaticoduodenectomy with pancreaticojejunostomy and duct occlusion without pancreaticojejunostomy. SUMMARY BACKGROUND DATA:Postoperative complications after pancreaticoduodenectomy are largely due to leak...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200210000-00004
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:To examine preoperative dietary influences on gut-associated lymphoid tissue (GALT) cell number in the context of postoperative infectious complications. BACKGROUND:There is little clinical evidence regarding whether nutritional routes affect GALT size and/or phenotype. The influence of GALT atrophy on clini...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827a0e05
更新日期:2013-12-01 00:00:00
abstract::We have demonstrated previously that oxygen-derived free radicals are important mediators of tissue injury following ischemia (total venous occlusion) and reperfusion in small (3 cm X 6 cm) island skin flaps in rats. In this study, we evaluated extension of this concept to regional ischemia in large (8 cm X 8 cm) acut...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198503000-00018
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:To investigate the long-term effect of cryopreservation on hepatocyte function, as well as attempt to improve cell viability and function through the utilization of the hypothermic preservation solution, HypoThermosol (HTS), as the carrier solution. SUMMARY BACKGROUND DATA:Advances in the field of bioartific...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000149303.48692.0f
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVE:To measure plasma levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and vascular endothelial growth factor (VEGF) early after trauma and to determine their clinical significance. BACKGROUND:Angiopoietins and VEGF play a central role in the physiology and pathophysiology of endothelial cells. Ang-2 ha...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318162d616
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. SUMMARY BACKGROUND DATA:Important developments in elective colorectal surgery are the introducti...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e31821fd1ce
更新日期:2011-12-01 00:00:00