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This article compares the success rates and adverse events of two alternative cannulation techniques, transpancreatic sphincterotomy (TPS) and needle knife sphincterotomy (NKS), in endoscopic retrograde cholangiopancreatography (ERCP) when standard guidewire technique with sphincterotomy is unsuccessful. The study analyzed data from the Swedish Registry for Gallstone Surgery and ERCP from 2011 to 2022, with a study population of 45,543 ERCP procedures. The results showed that TPS had a higher success rate of cannulation compared to NKS, but also had a higher occurrence of adverse events, particularly pancreatitis and perforation. The article concludes that TPS should be reserved for difficult situations and performed by skilled endoscopists. [Extracted from the article]

To study nurses' compliance to national guidelines (Sweden) for peripheral venous catheters and to establish the complication frequency connected to time in situ and bore size. Worldwide, there are no standard peripheral venous catheters guidelines, and the need for elective replacement has been challenged. Furthermore, the time interval and need for elective change of peripheral venous catheters has cost implications for hospitals. Prospective register study. The health care professionals in one surgical ward in a university hospital in the south of Sweden prospectively registered peripheral venous catheters parameters. Four hundred and thirteen peripheral venous catheters were registered for time in situ, size and complications. A cost analysis was performed. Non-parametric statistics were used, and p < 0·05 was regarded as significant. Compliance to the guideline of time in situ was 30·2%, and the frequency of thrombophlebitis was 6·5%. Peripheral venous catheters left in situ for more than 72 hours caused more thrombophlebitis ( p = 0·03). There was no difference in thrombophlebitis rate when peripheral venous catheters were changed within 24 hours compared with peripheral venous catheters that were changed within 72 hours. No difference was seen regarding complications between peripheral venous catheters sized 0·9 mm/22 gauge or 1·1 mm/20 gauge. The present Swedish national guidelines, advocating peripheral venous catheter change every 24 hours, should be altered since peripheral venous catheters left in situ for up to 72 hours were not found to be related to a greater risk of developing thrombophlebitis. Nor is it compatible with a greater risk to use a peripheral venous catheter of 1·1 mm/20 gauge instead of 0·9 mm/22 gauge. The change in guidelines would decrease money spent, 250 100 Euro in Sweden, thus allowing time for the nurses to do other tasks and save discomfort for the patients. National guidelines should be based on evidence and current facts, and evaluation of guidelines should be given priority. [ABSTRACT FROM AUTHOR]

Background/Aims: Two differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG), have previously been shown to reduce postoperative intra-abdominal adhesions. This study aims to investigate the possible toxic effects and to establish a lowest effective antiadhesive dose. Methods: 152 mice were investigated with a well-known adhesion model and given different concentrations of the two differently charged polypeptides as well as only the cationic PL. Results: For the first time, a probable toxic level of PL given intraperitoneally (40 mg/kg) and the lowest significant concentration of PL and PG for antiadhesive purposes (1.6 mg/kg) could be established. Conclusion: The gap between the possible toxicity level of PL and the lowest efficient antiadhesive dose is probably too narrow, and the shape and charge of PL warrant continuous research for another polycation in the concept of differently charged polypeptides used as antiadhesive agents. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article reports on a study conducted to evaluate prevention of peritoneal adhesions by combining charged polypeptides. A standardized peritoneal injury model was used in 48 NMRI mice where the length of adhesion formation was estimated and expressed in percentage of the standardized wound length 7 days and 4 weeks after adhesion induction. The test compounds, polylysine and polyglutamate, were administered intraperitoneally immediately following induction of the peritoneal defect. the study shows that polylysine together with polyglutamate caused a reproducible and significant decrease in the extent of peritoneal adhesions, also when administered in a low concentration.

This article focuses on a study related to the prevention of postoperative peritoneal adhesions by bioactive polymers. Intraperitoneal adhesions frequently occur after abdominal and pelvic surgery and may result in intestinal obstruction and potentially infertility. Various bioactive materials and macromolecules have been reported to decrease the extent of postoperative abdominal adhesions. Intraperitoneal administration of lysozyme, polyglutamate and especially a combination of polylysine and polyglutamate significantly decreased experimental abdominal adhesion formation.

Background: Pancreatic adenocarcinoma located in the pancreatic body might require a portomesenteric venous resection (PVR), but data regarding surgical risks after distal pancreatectomy (DP) with PVR are sparse. Insight into additional surgical risks of DP-PVR could support preoperative counseling and intraoperative decision making. This study aimed to provide insight into the surgical outcome of DP-PVR, including its potential risk elevation over standard DP., Methods: We conducted a retrospective, multicenter study including all patients with pancreatic adenocarcinoma who underwent DP ± PVR (2018-2020), registered in four audits for pancreatic surgery from North America, Germany, Sweden, and The Netherlands. Patients who underwent concomitant arterial and/or multivisceral resection(s) were excluded. Predictors for in-hospital/30-day major morbidity and mortality were investigated by logistic regression, correcting for each audit., Results: Overall, 2924 patients after DP were included, of whom 241 patients (8.2%) underwent DP-PVR. Rates of major morbidity (24% vs. 18%; p = 0.024) and post-pancreatectomy hemorrhage grade B/C (10% vs. 3%; p = 0.041) were higher after DP-PVR compared with standard DP. Mortality after DP-PVR and standard DP did not differ significantly (2% vs. 1%; p = 0.542). Predictors for major morbidity were PVR (odds ratio [OR] 1.500, 95% confidence interval [CI] 1.086-2.071) and conversion from minimally invasive to open surgery (OR 1.420, 95% CI 1.032-1.970). Predictors for mortality were higher age (OR 1.087, 95% CI 1.045-1.132), chronic obstructive pulmonary disease (OR 4.167, 95% CI 1.852-9.374), and conversion from minimally invasive to open surgery (OR 2.919, 95% CI 1.197-7.118), whereas concomitant PVR was not associated with mortality., Conclusions: PVR during DP for pancreatic adenocarcinoma in the pancreatic body is associated with increased morbidity, but can be performed safely in terms of mortality., (© 2024. The Author(s).)

Background: Periampullary diverticulum (PAD) is commonly encountered in endoscopic retrograde cholangiopancreatography (ERCP) procedures., Objectives: We sought to determine whether PADs are associated with a lower success rate of cannulation and an increased risk of adverse events., Design: A retrospective cohort study was conducted using prospectively gathered nationwide registry data., Methods: Using the Swedish registry for gallstone surgery and ERCP, we analyzed a cohort of 66,974 prospectively registered ERCP procedures performed in 2006-2021. The presence of PAD was divided into two groups based on the PAD type: Boix type 1 (the papilla located inside the PAD) and Boix types 2-3 (the papilla located either at the edge of the PAD or immediately adjacent to the PAD). The primary outcomes were the success rate of cannulation and overall adverse events within 30 days., Results: PADs were registered in 8130 (12.1%) of ERCPs included in the study population. In total, 2114 (3.9%) patients had Boix type 1 PAD, while 5035 (8.2%) patients had Boix type 2 or 3 PAD. The chance of successful cannulation was lower in patients with type 1 PAD compared to no PAD (80.1% vs 88.7%; odds ratio: 0.42, 95% confidence interval: 0.38-0.46). No differences were seen in overall adverse events or post-ERCP pancreatitis. Adverse events occurred in 14.6% of patients with PAD type 1 and 16.0% of patients with PAD type 2 or 3, compared to 16.5% of patients without a PAD., Conclusion: Cannulation appears less successful during ERCP when the papilla is located in the PAD (i.e., type 1). Adverse events seem not to increase with the presence of a PAD, but they could theoretically be influenced by the inability to cannulate., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Background: The efficacy and safety of minimally invasive distal pancreatectomy have been confirmed by randomized trials, but current patient selection and outcome of minimally invasive distal pancreatectomy in large international cohorts is unknown. This study aimed to compare the use and outcome of minimally invasive distal pancreatectomy in North America, the Netherlands, Germany, and Sweden., Methods: All patients in the 4 Global Audits on Pancreatic Surgery Group (GAPASURG) registries who underwent minimally invasive distal pancreatectomy or open distal pancreatectomy during 2014-2020 were included., Results: Overall, 20,158 distal pancreatectomies were included, of which 7,316 (36%) were minimally invasive distal pancreatectomies. Use of minimally invasive distal pancreatectomy varied from 29% to 54% among registries, of which 13% to 35% were performed robotically. Both the use of minimally invasive distal pancreatectomy and robotic surgery were the highest in the Netherlands. Patients undergoing minimally invasive distal pancreatectomy tended to have a younger age (Germany and Sweden), female sex (North America, Germany), higher body mass index (North America, the Netherlands, Germany), lower comorbidity classification (North America, Germany, Sweden), lower performance status (Germany), and lower rate of pancreatic adenocarcinoma (all). The minimally invasive distal pancreatectomy group had fewer vascular resections (all) and lower rates of severe complications and mortality (North America, Germany). In the multivariable regression analysis, country was associated with severe complications but not with 30-day mortality. Minimally invasive distal pancreatectomy was associated with a lower risk of 30-day mortality compared with open distal pancreatectomy (odds ratio 1.633, 95% CI 1.159-2.300, P = .005)., Conclusions: Considerable disparities were seen in the use of minimally invasive distal pancreatectomy among 4 transatlantic registries of pancreatic surgery. Overall, minimally invasive distal pancreatectomy was associated with decreased mortality as compared with open distal pancreatectomy. Differences in patient selection among countries could imply that countries are in different stages of the learning curve., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Minimally invasive pancreatoduodenectomy (MIPD) has emerged as an alternative to open pancreatoduodenectomy (OPD). However, the extent of variation in the use and outcomes of MIPD in relation to OPD among countries is unclear as international studies using registry data are lacking. This study aimed to investigate the use, patient selection, and outcomes of MIPD and OPD in four transatlantic audits for pancreatic surgery., Methods: A post hoc comparative analysis including consecutive patients after MIPD and OPD from four nationwide and multicenter pancreatic surgery audits from North America, Germany, the Netherlands, and Sweden (2014-2020). Patient factors related to MIPD were identified using multivariable logistic regression. Outcome analyses excluded the Swedish audit because < 100 MIPD were performed during the studied period., Results: Overall, 44,076 patients who underwent pancreatoduodenectomy were included (29,107 North America, 7586 Germany, 4970 the Netherlands, and 2413 Sweden), including 3328 MIPD procedures (8%). The use of MIPD varied widely among countries (absolute largest difference [ALD] 17%, p < 0.001): 7% North America, 4% Germany, 17% the Netherlands, and 0.1% Sweden. Over time, the use of MIPD increased in North America and the Netherlands (p < 0.001), mostly driven by robotic MIPD, but not in Germany (p = 0.297). Patient factors predicting the use of MIPD included country, later year of operation, better performance status, high POPF-risk score, no vascular resection, and non-malignant indication. Conversion rates were higher in laparoscopic MIPD (range 28-45%), compared to robotic MIPD (range 9-37%). In-hospital/30-day mortality differed among North America, Germany, and the Netherlands; MIPD (2%, 7%, 4%; ALD 5%, p < 0.001) and OPD (2%, 5%, 3%; ALD 3%, p < 0.001), similar to major morbidity; MIPD (25%, 42%, 38%, ALD 17%, p < 0.001) and OPD (25%, 31%, 30%, ALD 6%, p < 0.001), respectively., Conclusions: Considerable differences were found in the use and outcome, including conversion and mortality rates, of MIPD and OPD among four transatlantic audits for pancreatic surgery. Our findings highlight the need for international collaboration to optimize treatment standards and patient outcome., (© 2024. The Author(s).)