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Dr. Vidhyachandra Gandhi's review covers acute & chronic pancreatitis, pancreatic cancer, surgical complications, recent findings, and impact on clinical practice. It delves into drainage, prevention of pancreatic fistula, and compares different surgical techniques and outcomes.
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Landmark PublicationsPancreas Dr Vidhyachandra Gandhi DNB (GI Surgery), DNB (Gen Surgery) MNAMS, FSGE Gastrointestinal & HPB Surgeon Ruby Hall Clinic Pune IHPBA 2018
Period Jan 2017- Jan 2018Indexed JournalsRCT/Reviews/Meta analysis • Acute Pancreatitis • Chronic Pancreatitis • Carcinoma Pancreas • Pancreaticoduodenectomy &Complications • Cystic Neoplasms of Pancreas • Neuroendocrine tumors • Drains India • Journals - Annals of surgery/ Pancreas/ GUT/ Surgery/ NEJM/ BJS/Clinics of North America / Lancet
AP What is known ?
AP New Findings
AP Impact on clinical practice
POPF Grading ISGPF 2005 PCD – grade B or grade C ?
Expensive drug Adverse effects Cost effectiveness - overestimated No significant evidence NEJM trial - several pitfalls
Six RCT Primary outcomes: Postoperative pancreatic-associated morbidity (disease-specific), such as leakage from the pancreatic anastomosis/pancreatic fistula, DGE and biliary leakage Secondary Outcome : survival , blood loss, operative time, duration of hospital stay. QOL
IAP Meeting 2016, JAPAN ANATOMICAL
IAP Meeting 2016, JAPAN Main Concept
BIOLOGICAL CONDITIONAL
ConclusionPancreas – 2017/18 AP – lesser the better CP - Resectional / drainage procedures – equally good Pancreatic fistula (ISGPF) – Biochemical leak, Grade B, Grade C Post PD – Chyle leak defined and graded Classical PD vs PPPD – no difference PJ vs PG – surgeons choice Prevention of pancreatic fistula – long way to go Drains – place them and remove early BRPC – definition changed (anatomical, biochemical and conditional) Non functional PNET – scope for observation
Type 1 – leak from the side branches (parenchymal injuries, pancreatic biopsies, post Splenectomy) Type 2 – leak MPD (disrupted/disconnected duct syndrome) Type 3 – post pancreatectomy