CONTEXT: The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. OBJECTIVE: To investigate the specific impact of obesity on pancreaticoduodenectomy. DESIGN: A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. PATIENTS: Between 1999 and 2006, 92 consecutive patients underwent pancreaticoduodenectomy using a standardized technique. The study population was subdivided according to the presence or absence of obesity. RESULTS: Nineteen (20.7%) patients were obese and 73 (79.3%) patients were non-obese. The two groups were comparable in terms of demographics, American Society of Anesthesiology (ASA) score as well as nature and type of pancreatico-digestive anastomosis. The rate of clinically relevant pancreatic fistula (36.8% vs. 15.1%; P=0.050) and hospital stay (23.1+/-13.9 vs. 17.0+/-8.0 days; P=0.015) were significantly increased in obese vs. non-obese patients, respectively. Pancreatic fistula was responsible for one-half of the deaths (2/4) and two ruptured pseudoaneurysms. The incidence of the other procedure-related and general postoperative complications were not significantly different between the two groups. Intrapancreatic fat was increased in 10 obese patients (52.6%) and correlated positively both with BMI (P=0.001) and with the occurrence of pancreatic fistula (P=0.003). CONCLUSION: Obese patients are at increased risk for developing pancreatic fistula after pancreaticoduodenectomy. Special surgical caution as well as vigilant postoperative monitoring are therefore recommended in obese patients.
CONTEXT: The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. OBJECTIVE: To investigate the specific impact of obesity on pancreaticoduodenectomy. DESIGN: A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. PATIENTS: Between 1999 and 2006, 92 consecutive patients underwent pancreaticoduodenectomy using a standardized technique. The study population was subdivided according to the presence or absence of obesity. RESULTS: Nineteen (20.7%) patients were obese and 73 (79.3%) patients were non-obese. The two groups were comparable in terms of demographics, American Society of Anesthesiology (ASA) score as well as nature and type of pancreatico-digestive anastomosis. The rate of clinically relevant pancreatic fistula (36.8% vs. 15.1%; P=0.050) and hospital stay (23.1+/-13.9 vs. 17.0+/-8.0 days; P=0.015) were significantly increased in obese vs. non-obesepatients, respectively. Pancreatic fistula was responsible for one-half of the deaths (2/4) and two ruptured pseudoaneurysms. The incidence of the other procedure-related and general postoperative complications were not significantly different between the two groups. Intrapancreatic fat was increased in 10 obesepatients (52.6%) and correlated positively both with BMI (P=0.001) and with the occurrence of pancreatic fistula (P=0.003). CONCLUSION:Obesepatients are at increased risk for developing pancreatic fistula after pancreaticoduodenectomy. Special surgical caution as well as vigilant postoperative monitoring are therefore recommended in obesepatients.
Authors: Robert M Cannon; Ryan LeGrand; Ryaz B Chagpar; Syed A Ahmad; Rebecca McClaine; Hong Jin Kim; Christopher Rupp; Cliff S Cho; Adam Brinkman; Sharon Weber; Emily R Winslow; David A Kooby; Carrie K Chu; Charles A Staley; Ian Glenn; William G Hawkins; Alexander A Parikh; Nipun B Merchant; Kelly M McMasters; Robert C G Martin; Glenda G Callender; Charles R Scoggins Journal: HPB (Oxford) Date: 2012-01-19 Impact factor: 3.647
Authors: Marco Del Chiaro; Elena Rangelova; Christoph Ansorge; John Blomberg; Ralf Segersvärd Journal: World J Gastrointest Pathophysiol Date: 2013-05-15
Authors: Saboor Khan; Guido Sclabas; Kaye Reid-Lombardo; Michael G Sarr; David Nagorney; Michael L Kendrick; Florencia G Que; John H Donohue; Marianne Huebner; Christine Lohse; Michael B Farnell Journal: J Gastrointest Surg Date: 2010-07-30 Impact factor: 3.452
Authors: Susan Tsai; Michael A Choti; Lia Assumpcao; John L Cameron; Ana L Gleisner; Joseph M Herman; Frederic Eckhauser; Barish H Edil; Richard D Schulick; Christopher L Wolfgang; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2010-04-30 Impact factor: 3.452
Authors: John C McAuliffe; Karen Parks; Prakash Kumar; Sandre F McNeal; Desiree E Morgan; John D Christein Journal: HPB (Oxford) Date: 2013-01-10 Impact factor: 3.647