Biomedical subjects

T L Hwang

Publications and source records attributed to T L Hwang.

119 records · Page 7Linked to original sources

PubMedDate not supplied

Secural pancreaticojejunal anastomosis for the pancreaticoduodenectomy.

BACKGROUND/AIMS: This report presents the results of two methods for minimizing complications following a Whipple operation. MATERIALS AND METHODS: In the past five years, continuous duct to mucosal suture with end to side anastomosis of the pancreaticojejunostomy was utilized in 30 patients. Another 50 patients received interrupted duct to mucosal suturing with end to side anastomosis of the pancreaticojejunostomy in the past five to ten years. RESULTS: None of the first set of 30 patients suffered leakage after the operation. Ten of the 50 patients (20%) developed leakage postoperatively and 3 (6%) died. The group with continuous duct to mucosal suture had significantly less complications than those with interrupted duct to mucosal suturing (P < 0.05). Late follow up of the patients with continuous duct to mucosal suture using echogram, no one had stricture of the anastomosis. CONCLUSION: The continuous duct to mucosal suture of the pancreaticojejunostomy is a very safe procedure, minimizing the operative morbidity and mortality of the Whipple operation.

Follow-Up Studies↗

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Factors influencing survival after hepatectomy for peripheral cholangiocarcinoma.

BACKGROUND/AIMS: Radical resection for patients with peripheral cholangiocarcinoma is rare. Prognostic factors related to survival with peripheral cholangiocarcinoma after hepatectomy have not yet been reported. MATERIALS AND METHODS: Of 41 hepatectomized patients with peripheral cholangiocarcinoma, a computer analysis of 14 clinicopathological factors on patients survival was performed with univariate and multivariate analysis. RESULTS: Median and mean survival times for patients with peripheral cholangiocarcinoma after hepatectomy were 12.0 and 22.8 months. The 1-, 2-, 3-, 4- and 5-year survival rates were 53.7%, 39.0%, 36.6%, 26.8%, and 26.8% respectively. Univariate analysis of overall survival involving all patients identified 7 factors that were associated with a significantly outcome: mucobilia (p = 0.043), capsular invasion (p = 0.007), tumor spreading type (p = 0.0003), section margin (p = 0.001), histologic type (p = 0.008), macroscopic and microscopic vascular involvement (p = 0.031), and lymphatic invasion (p = 0.004). With multivariate analysis using the COX stepwise proportional hazards model, only mucobilia, tumor spreading type and section margin were significantly related to prognosis. CONCLUSIONS: Intrahepatic bile duct carcinoma patients with mucobilia, intraductal papillomatosis and a tumor-free margin after hepatectomy had a better prognosis.

Bile Duct Neoplasms↗

PubMedDate not supplied

Surgical treatment of pancreatic adenocarcinoma: Taiwan experience.

A retrospective study of 155 patients with tissue proven ductal adenocarcinoma of the pancreas treated between January 1981 and December 1991 was performed. Locations of the pancreatic tumors were: pancreatic head in 109 cases (70.3%), head and body or diffusely throughout the gland in 24 patients (15.5%), body and/or tail in another 22 (14.2%). All of the patients were stratified by TNM staging (I, 13.6%; II, 8.4%; III, 34.8%; IV, 43.2%). Twenty-eight patients received pancreatectomies (18.1%), 87 patients had biliary-enteric bypass and/or gastrojejunostomies (56.1%), and another 40 received laparotomies with tumor biopsy only (25.8%). The overall operative mortality of pancreatic cancer surgery was 9.0% with the pancreatectomy, bypass, laparotomy group mortalities at 7.1%, 5.7%, and 17.5% respectively. The risk factors of postoperative mortality were age > or = 70 years, serum albumin 3.0 g% and hemoglobulin < 12.0 g% (p < 0.05). The overall long term survival for pancreatic cancer was: 1y, 17.1%; 2y, 8.5%; 3y, 7.6%; 4y, 5.7%; and 5y, 4.8%; respectively. The mean survival time for the resection group was 23.6M (range 1-108M) with survival rates being: 1y, 42.3%; 2y, 34.6%; 3y, 30.8%; 4y, 23.1%; and 5y, 19.2%; respectively. Stage I cancer and radical resection are two important factors related to long-term survival in patients with pancreatic adenocarcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Surgical results for severe acute pancreatitis--comparison of the different surgical procedures.

BACKGROUND/AIMS: We compared the outcome of surgery for the patients with severe acute pancreatitis using different surgical procedures to find risk factors for mortality. PATIENTS AND METHODS: Records of eighty six patients with severe acute pancreatitis who underwent different surgical procedures in the past five years were retrospectively reviewed. RESULTS: The patients were found to have severe acute pancreatitis during operation. The morbidity and mortality of three different surgical procedures were compared. The risk factors related to the mortality were analyzed. Thirty one patients considered as group A received debridement and closed sump drainage. Forty patients considered as group B receiving necrosectomy with open packing of the peripancreatic space. The other 15 patients considered as group C received debridement and continuous lavage of the lesser sac. The patients in group A had highest mortality (48.4%) and those in group B had lowest (15%). CONCLUSIONS: The significant risk factors of mortality included high Ranson's signs, peripancreatic necrosis, pancreaticogenic ascites and bacterial infection. The open packing or marsupialization of group B provided an easy way to perform repeated debridement after the first operation, resulting in the lower mortality for severe acute pancreatitis than other surgical procedures. The procedure with closed sump drainage resulted in higher incidence of postoperative bleeding and sepsis. The patients with higher Ranson's signs, peripancreatic necrosis, pancreatic ascites or positive bacterial infection should be treated more aggressively.

Acute Disease↗

PubMedDate not supplied

Surgical results of corrosive injuries involving esophagus to jejunum.

BACKGROUND/AIM: Severe corrosive injury involving esophagus to jejunum remains an unique surgical problem which is associated with high mortality and morbidity. MATERIAL AND METHODS: Herein we report the outcomes of 28 caustic patients who underwent resections of the stomach, duodenum, a segment of jejunum, and adjacent involving organs. RESULTS: In all of these patients except one, esophagectomy was also performed. The concomitant procedures included pancreaticojejunostomy (n = 24), choledochojejunosotmy (n = 4), cholecystostomy (n = 4), common bile duct or pancreatic duct drainage, feeding and drainage jejunostomies, and cervical esophagostomy. Major complications consisted of bile leakage (n = 10), bile-bronchial fistula (n = 2), internal bleeding due to vessel necrosis (n = 5), peritonitis (n = 4), acute renal failure (n = 4), and septicemia (n = 4). There were 13 hospital deaths (46.4%) and three late deaths. Eight out of 12 survivors underwent subsequent reconstruction of esophagus. The remaining four survivors depended on jejunostomy feeding. CONCLUSIONS: Early approaches and appropriate procedures can save a number of patients with corrosive injury involving esophagus to jejunum.

Adult↗

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Surgical treatment of gastric outlet obstruction after corrosive injury--can early definitive operation be used instead of staged operation?

For the comparison of advantage and outcome, thirty six patients with corrosive upper GI injury resulting in only distal gastric outlet obstruction and failing to receive endoscopic balloon dilatation underwent prospective randomized different surgical treatments in the past years. Sixteen patients (Group A) received early definitive treatment with antrectomy or pyloroplasty for their gastric outlet obstruction, only 3 (18.8%) of them needed a second operation for the delayed esophageal stricture. The long-term follow-up for these patients revealed the stricture resolved after the antrectomy or pyloroplasty. All of the other 20 patients (Group B) who received gastrostomy plus feeding jejunostomy during their first operation required a second operation. Among the 20 patients receiving a second operation, delayed esophageal stricture was the reason in only 4 patients. It meant that 16 patients (80%) of Group B were able to avoid the second operation if early definitive treatment for their gastric outlet obstruction was performed during the first operation. We concluded that the early definitive treatment of gastric outlet obstruction can give patients a better quality of life, avoid a second operation in about 80% of them and save operative time in those who need a second operation for final esophageal reconstruction.

Burns, Chemical↗

PubMedDate not supplied

Surgical treatment of choledochal cyst in adults: results and long-term follow-up.

BACKGROUND/AIMS: Results of the surgical management of 60 adults with choledochal cysts at Chang Gung Memorial Hospital Taipei are presented. PATIENTS AND METHODS: All patients were diagnosed and surgically managed during the period between March 1979 and December 1992. There were 47 females and 13 males, with ages ranging from 16 to 81 years (mean age = 31.9 years). Of the total, there were 41 Type I, one Type II, 14 Type IV, and four Type V choledochal cysts classified according to Todani's classification system. The definite surgical procedures were cyst excision and hepatico-jejunostomy in 43 cases in type I and IV diseases, one cyst excision in type II disease, two hepatectomy for type V disease, cyst enterostomy in seven cases, and T-tube choledochocystostomy in seven cases. RESULTS: The operative mortality rate was 3.3% and the complication rate related to the surgical procedure was 20%. Early postoperative complications include wound infection, leakage of anastomosis, acute pancreatitis, septic shock, left pleural effusion, and intra-abdominal abscessing. Reoperations were needed in the early postoperative days in two cases due to hepatico-jejunostomy leakage and intraabdominal abscess formation. Long-term surgical outcome, concerning recurrence of symptoms, was related to the following factors, excluding the factors of surgery: presence of bile duct lithiasis, common channel less than 22 mm, presence of preoperative pancreatitis and acute angle type pancreaticobiliary unions. Only common channel less than 22 mm is statistically significant. The percentage of recurrence of the symptoms after resectional surgery was 32.5% in the long term follow-up period. Most of the cases responded well to an antibiotics treatment. Three of the cases required a second operation or PTCD as well as dilatation to treat the recurrent cholangitis. CONCLUSION: Although the recurrence of symptoms is not uncommon and satisfactory explanation of the analysed factors is still the treatment of choice for adult patients with choledochal cysts.

Adolescent↗

PubMedDate not supplied

Massive extra-enteric gastrointestinal hemorrhage secondary to splanchnic artery aneurysms.

BACKGROUND/AIMS: Gastrointestinal hemorrhages of obscure origin are often difficult to diagnose and manage. Of these, splanchnic artery aneurysms have emerged as an important disorder because of the increasing prevalence and formidable mortality rate associated with their rupture. We herein evaluated extra-enteric gastrointestinal bleeding related to these ruptured aneurysms. METHODOLOGY: The medical records of 17 patients with splanchnic artery aneurysms known to be exclusively manifested as gastrointestinal bleeding were reviewed. The pathogenesis, clinical picture, diagnostic tests, management, complications, and outcomes were compiled and analyzed. RESULTS: Of the seventeen patients, 12 patients had true aneurysms; 5 patients had false aneurysms. Pancreatitis, trauma, iatrogenic hepatobiliary injury, and atherosclerosis were the four major etiologies. The sensitivity rates measured by endoscopy, ultrasonography, computed tomography and visceral angiography were 20%, 50%, 67%, and 100%, respectively. An exact diagnosis was attained in 94% of the patients at the time of management. Transcatheter embolization was employed in 7 patients, complicated with hepatic and splenic infarcts, and pyogenic liver abscesses in 2 instances. Two patients had recurrent bleeding aneurysms post embolotherapy. Ten patients underwent surgical intervention which resulted in 2 cases of hepatic failure. One out of 5 patients with a true aneurysm died, while 4 out of 12 patients with false aneurysms eventually died. Overall, the mortality rate was 29%. CONCLUSION: Even though the exact diagnosis can be made in most of the patients by modern imaging studies, the mortality rate was still formidable, especially in patients with false aneurysms, in whom the underlying causal diseases substantially influenced the major outcome.

Adult↗

PubMedDate not supplied

Concurrent primary carcinoma of the gallbladder and acute cholecystitis.

BACKGROUND/AIMS: Primary carcinoma of the gallbladder is rare and associated with a late diagnosis and poor prognosis. Concurrent acute cholecystitis frequently obscures the presence of carcinoma. The information regarding gallbladder carcinoma with acute cholecystitis is limited. In order to better understand the presentation of gallbladder carcinoma with acute cholecystitis, we retrospectively reviewed the data of patients with primary carcinoma of the gallbladder. METHODOLOGY: The data of 86 patients with primary carcinoma of the gallbladder treated between 1979 and 1994 were compiled and reviewed. The patients were divided into 2 groups: Group 1 (with acute cholecystitis, 21 patients) and Group 2 (without cholecystitis, 65 patients). Clinicopathological comparisons were made and evaluated between these two groups RESULTS: The average age of Group 1 patients was older than that of Group 2 patients (75+/-2 years vs. 63+/-2 years; p<0.05). Three Group 1 patients presented with sepsis. The interval between the onset of symptoms and hospital admission in Group 2 patients was significantly (p<0.05) longer than that in Group 1 patients (243+/-95 days vs. 20+/-11 days). Leukocytosis (>11,000/mm3) was more common in Group 1 patients than in Group 2 patients (47.6% vs. 15.4%). Jaundice was more common in Group 2, and fever was common in Group 1. The majority of Group 2 gallbladder cancers were stage V (75.4%). In contrast, 52.4% of Group 1 gallbladder cancers were stage III and 38.1% were stage V. The 30-day postoperative mortality rate in Group 1 and Group 2 patients was 9.5% and 7.7%, respectively. The cumulative survival of Group 1 patients was not different from that of Group 2 patients (log-rank test, p>0.05). CONCLUSIONS: Age, the interval of symptoms prior to admission, the location of abdominal pain, fever, leukocytosis, and the absence of jaundice suggested the presence of acute cholecystitis in gallbladder carcinoma. A high index of suspicion of the disease, intraoperative examination of gallbladder specimens, and more aggressive surgical treatment may improve patient survival.

Acute Disease↗

PubMedDate not supplied

A multidisciplinary approach to major bile duct injury following laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: Many series describing the management of major bile duct injuries after laparoscopic cholecystectomy have been reported with satisfactory short-term results. However, the information of their prognosis with sufficient time-period follow-up is sparse. METHODS: Sixteen consecutive patients with major bile duct injury following laparoscopic cholecystectomy were retrospectively reviewed, including six common bile duct transections, four bile duct perforations, and six hilar strictures but without perforation. With respect to the level of bile duct injuries, there were the following based on Bismuth's classification: type 1 in six patients, type 2 in five patients, type 3 in three patients, type 4 in one patient, and type 5 in one patient. All patients received surgical management, interventional radiology and endoscopic treatment. The time periods of follow-up ranged from 37 to 72 months (mean, 52 months). The final results were rated as being excellent, good, fair, or poor, based on the criteria of symptoms, biochemical data, and radiology. RESULTS: There was no procedure-related mortality. Ten of the 16 patients had either excellent or good results, two had fair results, and four had poor results. Of the latter four, the patients had been classified as Bismuth type 1, 3, 4, and 5, respectively, and all sustained a failed initial surgical repair. CONCLUSIONS: Using a multidisciplinary approach, 12 (75%) of the 16 patients attained a promising result through a long-term follow-up, while those with the higher biliary stricture and with an unsuccessful initial surgical repair had a disappointing outcome.

Adult↗

PubMedDate not supplied

Clinical analysis of inflammatory masses of the pancreatic head region.

BACKGROUND/AIMS: Inflammatory masses of the pancreatic head are a dilemma for surgeons, especially when the differences between these lesions and pancreatic head carcinoma are not so clear. The surgical management of these inflammatory benign lesions is also a topic with conflicting opinions. A clinical analysis was performed in an attempt to differentiate between these lesions and malignancy. The results of our observatory strategy of these lesions are also presented. METHODOLOGY: From 1992 to 1994, 73 patients with ultrasonographically (US) or computed tomographically (CT) heterogenous pancreatic head lesions were diagnosed at the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. Forty-nine of these lesions were neoplastic (Group I), but the remaining 24 patients had inflammatory non-neoplastic lesions (pancreatic inflammatory masses, IPM, Group II), which were diagnosed during laparotomy by core needle biopsy. Surgery and outcome were reviewed. Ten of the 24 patients in group II received biopsy only, and the remaining 14 patients received bypass procedures. At follow-up of at least 16 months of the surviving patients (n=21), only 9.5% were with residual lesions. All cases in group II revealed shrinkage of masses. We focused on the clinical features, hematology, biochemistry, image study, serum CEA and CA 19-9, and compared these variances between the 2 groups. RESULTS: Three clinical features were statistically different between groups I and II: mean age at presentation of disease (group I vs II = 53.3 vs 65.1), the tendency of a past history of alcoholism (Group II), and presence of abdominal pain (Group II). Group II also showed a higher level of serum alkaline phosphatase and a lower level of total bilirubin as well as a lower level of CA19-9. These inflammatory masses could not be distinguished from the true neoplasms pre-operatively on endoscopic appearance, US, or CT. CONCLUSIONS: Pre-operative differentiation between these pancreatic lesions may be difficult but laparotomy and core needle biopsy remain safe and reliable procedures. Our short-term follow-up justified the bypass surgery and that observatory strategy is enough for those patients with pancreatic head inflammatory masses.

Adolescent↗