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Iatrogenic biliary injuries: a multi institutional experience
S156
ePoster Abstracts
Conclusion: This population-based study showed the incidence of pancreatic cancer is slowly increasing in patients <40 years. Patients with early-stage cancers have same survival regardless of age but younger patients have better OS for locally advanced disease. Younger patients are offered more resections than older counterparts.
1980 (1). The prevalence of obesity in the United States is very high, around 28.9% (2) and obesity has been associated with both the increased risk of developing pancreatic cancer and the higher rate of postoperative complications (3, 4). Several studies have studied the influence of BMI on Whipple procedures, by defining obese either those with BMI > 30 or those with BMI > 25 (3, 5, 6).
Table 1 3 and 5 year overall and cause specific survival of the young versus older population (% ages)
Young
Early stage (Stage I)
Resectable/Borderline (stage IIA, IIB, III) Metastatic (Stage IV)
Old
P value OS
P value CSS
55.4/46.4
0.39
0.14
10.5/9.1
0.13
0.57
22.3/13.4
31.9/22.1
<0.001
0.006
3.1/1.6
7.1/4.2
0.28
0.92
1.4/0.6
3.5/1.8
<0.001
0.005
Median survival OS/CSS
3/5 year OS
3/5 year CSS
Median survival OS/CSS
3/5 year OS
3/5 year CSS
Operated
21/21
25.0/25.0
25.0/25.0
32/49
44.7/35.2
Non operated
10/10
17.9/17.9
17.9/17.9
6/9
3.8/2.3
Operated
37/39
50.3/34.5
56.4/38.7
17/22
Non operated
10/10
2.5/0.0
6.3/0.0
7/9
6/7
5.4/4.3
7.1/5.7
3/4
P87 IATROGENIC BILIARY INJURIES: A MULTI INSTITUTIONAL EXPERIENCE J. Sabogal, R. Tabarez, C. Diaz and A. Isaza Mederi Hospital and San Ignacio Hospital, Bogota, Colombia Objective: To review incidence of iatrogenic biliary injuries on three different HPB referral centre. Methods: A total of 14 patients were included in 24 months in this retrospective cohort study. The patients enrolled on this study are from three HPB referral centre. Demographic, surgical findings and surgical reconstruction were analysed. Results: This HPB referral centres are performing 600e800 laparoscopic cholecystectomy per year. Three patients were from San Ignacio Hospital, two patients from Policy Hospital and 9 patients were from Mederi Hospital in 24 months. The median age was 52 years old. The majority of patients were women. Lesions were classified Strasberg E1 (7) 50%, Strasberg E2 (1) 7.14% Strasberg E4 (3) 21.48% Strasberg E5 (1) 7.14% Strasberg D (2) 14.28%. All patients were reconstructed in the first 2 weeks after the iatrogenic lesions with a Roux en Y Hepatojejunostomy. Early medical complications were one patient with acute myocardial infarction. One 85 years-old patient had a PE two weeks after surgery. No stent or drains were used. No fistulas were reported. Conclusion: Biliary iatrogenic injuries still are frequent. Roux en Y hepaticojejunostomy is a safe technique with low rate fistula or any other surgical complications. Drains or stent are not recommended. HPB centre are attending more patients with iatrogenic biliary injuries.
P88 IMPACT OF CLASS III OBESITY ON 30 DAYS MORTALITY AND MORBIDITY AFTER WHIPPLE PROCEDURE Konstantinos A. Zorbas and Andreas Karachristos Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA Objective: Obesity constitutes a worldwide epidemic, as the mean Body Mass Index (BMI) increases globally since
Methods: The ACS-NSQIP database reviewed to identify patients who underwent Whipple procedure. After excluding all non-elective cases and cases with inadequate information on the studied parameters, patients were divided into three groups based on BMI: Group 1BMI < 30, Group 2-BMI 30e39.9 and Group 3-BMI 40. The three groups compared each other regarding with the percentages of mortality, morbidity, and each complication separated. Morbidity defined the occurrence of at least one of the complications of table 1. Results: Of 4280 cases of pancreaticoduodenectomy, 3793 were elective and 2677 had adequate information. Statistically significant differences were discovered between the first group and the third group in the following variables: 1) overall morbidity (47.8%% vs 65.2%, p = 0.001), 2) pancreatic fistula (16.1% vs 30.4%, p 0.0005), 3) DSSI (2.6% vs 7.6%, p = 0.016), 4) OSSI (11.6% vs 20.7%, p < 0.0005), 4) PE (0.9% vs 2.2%, p = 0.048), PPRF (0.4% vs 3.3%, p = 0.003), CA (0.9% vs 4.3%, p = 0.002), UTI (4.2% vs 8.7%, p = 0.021) and SISSI (8.9% vs 15.2%, p = 0.046). Conclusion: Class III Obesity associated with higher percentages of complications after Whipple procedure. Table 1 Abbreviations of complications.
PF
Pancreatic fistula
DSSI
Deep incisional surgical specific infections
OSSI
Organ space SSI
SISSI
Superficial incisional SSI
PNEU
Pneumonia
UI
Unplanned intubation
PE
Pulmonary embolism
V48
Ventilation for >48 hours after surgery completion
PPRF
Progressive postoperative renal failure
APRF
Acute postoperative renal failure
UTI
Urinary tract infection
CVA
Cerebrovascular accident
CA
Cardiac arrest
MI
Myocardial infarction
Blee
Bleeding (intraoperative or postoperative)
DVT
Deep vein thrombosis
S
Sepsis
SS
Septic shock
HPB 2017, 19 (S1), S120eS192
ePoster Abstracts
Conclusion: This population-based study showed the incidence of pancreatic cancer is slowly increasing in patients <40 years. Patients with early-stage cancers have same survival regardless of age but younger patients have better OS for locally advanced disease. Younger patients are offered more resections than older counterparts.
1980 (1). The prevalence of obesity in the United States is very high, around 28.9% (2) and obesity has been associated with both the increased risk of developing pancreatic cancer and the higher rate of postoperative complications (3, 4). Several studies have studied the influence of BMI on Whipple procedures, by defining obese either those with BMI > 30 or those with BMI > 25 (3, 5, 6).
Table 1 3 and 5 year overall and cause specific survival of the young versus older population (% ages)
Young
Early stage (Stage I)
Resectable/Borderline (stage IIA, IIB, III) Metastatic (Stage IV)
Old
P value OS
P value CSS
55.4/46.4
0.39
0.14
10.5/9.1
0.13
0.57
22.3/13.4
31.9/22.1
<0.001
0.006
3.1/1.6
7.1/4.2
0.28
0.92
1.4/0.6
3.5/1.8
<0.001
0.005
Median survival OS/CSS
3/5 year OS
3/5 year CSS
Median survival OS/CSS
3/5 year OS
3/5 year CSS
Operated
21/21
25.0/25.0
25.0/25.0
32/49
44.7/35.2
Non operated
10/10
17.9/17.9
17.9/17.9
6/9
3.8/2.3
Operated
37/39
50.3/34.5
56.4/38.7
17/22
Non operated
10/10
2.5/0.0
6.3/0.0
7/9
6/7
5.4/4.3
7.1/5.7
3/4
P87 IATROGENIC BILIARY INJURIES: A MULTI INSTITUTIONAL EXPERIENCE J. Sabogal, R. Tabarez, C. Diaz and A. Isaza Mederi Hospital and San Ignacio Hospital, Bogota, Colombia Objective: To review incidence of iatrogenic biliary injuries on three different HPB referral centre. Methods: A total of 14 patients were included in 24 months in this retrospective cohort study. The patients enrolled on this study are from three HPB referral centre. Demographic, surgical findings and surgical reconstruction were analysed. Results: This HPB referral centres are performing 600e800 laparoscopic cholecystectomy per year. Three patients were from San Ignacio Hospital, two patients from Policy Hospital and 9 patients were from Mederi Hospital in 24 months. The median age was 52 years old. The majority of patients were women. Lesions were classified Strasberg E1 (7) 50%, Strasberg E2 (1) 7.14% Strasberg E4 (3) 21.48% Strasberg E5 (1) 7.14% Strasberg D (2) 14.28%. All patients were reconstructed in the first 2 weeks after the iatrogenic lesions with a Roux en Y Hepatojejunostomy. Early medical complications were one patient with acute myocardial infarction. One 85 years-old patient had a PE two weeks after surgery. No stent or drains were used. No fistulas were reported. Conclusion: Biliary iatrogenic injuries still are frequent. Roux en Y hepaticojejunostomy is a safe technique with low rate fistula or any other surgical complications. Drains or stent are not recommended. HPB centre are attending more patients with iatrogenic biliary injuries.
P88 IMPACT OF CLASS III OBESITY ON 30 DAYS MORTALITY AND MORBIDITY AFTER WHIPPLE PROCEDURE Konstantinos A. Zorbas and Andreas Karachristos Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA Objective: Obesity constitutes a worldwide epidemic, as the mean Body Mass Index (BMI) increases globally since
Methods: The ACS-NSQIP database reviewed to identify patients who underwent Whipple procedure. After excluding all non-elective cases and cases with inadequate information on the studied parameters, patients were divided into three groups based on BMI: Group 1BMI < 30, Group 2-BMI 30e39.9 and Group 3-BMI 40. The three groups compared each other regarding with the percentages of mortality, morbidity, and each complication separated. Morbidity defined the occurrence of at least one of the complications of table 1. Results: Of 4280 cases of pancreaticoduodenectomy, 3793 were elective and 2677 had adequate information. Statistically significant differences were discovered between the first group and the third group in the following variables: 1) overall morbidity (47.8%% vs 65.2%, p = 0.001), 2) pancreatic fistula (16.1% vs 30.4%, p 0.0005), 3) DSSI (2.6% vs 7.6%, p = 0.016), 4) OSSI (11.6% vs 20.7%, p < 0.0005), 4) PE (0.9% vs 2.2%, p = 0.048), PPRF (0.4% vs 3.3%, p = 0.003), CA (0.9% vs 4.3%, p = 0.002), UTI (4.2% vs 8.7%, p = 0.021) and SISSI (8.9% vs 15.2%, p = 0.046). Conclusion: Class III Obesity associated with higher percentages of complications after Whipple procedure. Table 1 Abbreviations of complications.
PF
Pancreatic fistula
DSSI
Deep incisional surgical specific infections
OSSI
Organ space SSI
SISSI
Superficial incisional SSI
PNEU
Pneumonia
UI
Unplanned intubation
PE
Pulmonary embolism
V48
Ventilation for >48 hours after surgery completion
PPRF
Progressive postoperative renal failure
APRF
Acute postoperative renal failure
UTI
Urinary tract infection
CVA
Cerebrovascular accident
CA
Cardiac arrest
MI
Myocardial infarction
Blee
Bleeding (intraoperative or postoperative)
DVT
Deep vein thrombosis
S
Sepsis
SS
Septic shock
HPB 2017, 19 (S1), S120eS192