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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy
World Journal of Gastroenterology, Volume 19, No. 41, Year 2013
Notification
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Description
AIM: To elucidate surgical outcomes of pancreaticoduodenectomy (PD) in patients with liver cirrhosis. METHODS: We studied retrospectively all patients who underwent PD in our centre between January 2002 and December 2011. Group A comprised patients with cirrhotic livers, and Group B comprised patients with non-cirrhotic livers. The cirrhotic patients had Child- Pugh classes A and B (patient's score less than 8). Preoperative demographic data, intra-operative data and postoperative details were collected. The primary outcome measure was hospital mortality rate. Secondary outcomes analysed included duration of the operation, postoperative hospital stay, postoperative morbidity and survival rate. RESULTS: Only 67/442 patients (15.2%) had cirrhotic livers. Intraoperative blood loss and blood transfusion were significantly higher in group A (P = 0.0001). The mean surgical time in group A was significantly longer than that in group B (P = 0.0001). Wound complications (P = 0.02), internal haemorrhage (P = 0.05), pancreatic fistula (P = 0.02) and hospital mortality (P = 0.0001) were significantly higher in the cirrhotic patients. Postoperative stay was significantly longer in group A (P = 0.03). The median survival was 19 mo in group A and 24 mo in group B. Portal hypertension (PHT) was present in 16/67 cases of cirrhosis (23.9%). The intraoperative blood loss and blood transfusion were significantly higher in patients with PHT (P = 0.001). Postoperative morbidity (0.07) and hospital mortality (P = 0.007) were higher in cirrhotic patients with PHT. CONCLUSION: Patients with periampullary tumours and well-compensated chronic liver disease should be routinely considered for PD at high volume centres with available expertise to manage liver cirrhosis. PD is associated with an increased risk of postoperative morbidity in patients with liver cirrhosis; therefore, it is only recommended in patients with Child A cirrhosis without portal hypertension. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.
Authors & Co-Authors
El Nakeeb, Ayman M.
Egypt, Mansoura
Gastrointestinal Surgery Center
Sultan, Ahmad M.
Egypt, Mansoura
Gastrointestinal Surgery Center
Salah, Tarek
Egypt, Mansoura
Gastrointestinal Surgery Center
El Hemaly, Mohamed M.
Egypt, Mansoura
Gastrointestinal Surgery Center
Hamdy, Emad
Egypt, Mansoura
Gastrointestinal Surgery Center
Salem, Ali L.
Egypt, Mansoura
Gastrointestinal Surgery Center
Moneer, Ahmed
Egypt, Mansoura
Gastrointestinal Surgery Center
Said, Rami
Egypt, Mansoura
Gastrointestinal Surgery Center
AbuEleneen, Ahmed
Egypt, Mansoura
Gastrointestinal Surgery Center
Abu Zeid, Mostafa S.O.
Egypt, Mansoura
Gastrointestinal Surgery Center
Abdallah, Talaat
Egypt, Mansoura
Gastrointestinal Surgery Center
Abd Elwahab, M. M.
Egypt, Mansoura
Gastrointestinal Surgery Center
Statistics
Citations: 45
Authors: 12
Affiliations: 1
Identifiers
Doi:
10.3748/wjg.v19.i41.7129
ISSN:
10079327
Research Areas
Health System And Policy
Maternal And Child Health
Noncommunicable Diseases