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Pim B. Olthof Robert J.S. Coelen Jimme K. Wiggers Marc G.H. Besselink Olivier R.C. Busch Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2016,18(4):348-353
BackgroundPreoperative biliary drainage is considered essential in perihilar cholangiocarcinoma (PHC) requiring major hepatectomy with biliary-enteric reconstruction. However, evidence for postoperative biliary drainage as to protect the anastomosis is currently lacking. This study investigated the impact of postoperative external biliary drainage on the development of post-hepatectomy biliary leakage and liver failure (PHLF).MethodsAll patients who underwent major liver resection for suspected PHC between 2000 and 2015 were retrospectively analyzed. Biliary leakage and PHLF was defined as grade B or higher according to the International Study Group of Liver Surgery (ISGLS) criteria.ResultsEighty-nine out of 125 (71%) patients had postoperative external biliary drainage. PHLF was more prevalent in the drain group (29% versus 6%; P = 0.004). There was no difference in the incidence of biliary leakage (32% versus 36%). On multivariable analysis, postoperative external biliary drainage was identified as an independent risk factor for PHLF (Odds-ratio 10.3, 95% confidence interval 2.1–50.4; P = 0.004).ConclusionsExternal biliary drainage following major hepatectomy for PHC was associated with an increased incidence of PHLF. It is therefore not recommended to routinely use postoperative external biliary drainage, especially as there is no evidence that this decreases the risk of biliary anastomotic leakage. 相似文献
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Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial 总被引:1,自引:0,他引:1
Besselink MG van Santvoort HC Buskens E Boermeester MA van Goor H Timmerman HM Nieuwenhuijs VB Bollen TL van Ramshorst B Witteman BJ Rosman C Ploeg RJ Brink MA Schaapherder AF Dejong CH Wahab PJ van Laarhoven CJ van der Harst E van Eijck CH Cuesta MA Akkermans LM Gooszen HG;Dutch Acute Pancreatitis Study Group 《Lancet》2008,371(9613):651-659
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van Santvoort HC Bakker OJ Bollen TL Besselink MG Ahmed Ali U Schrijver AM Boermeester MA van Goor H Dejong CH van Eijck CH van Ramshorst B Schaapherder AF van der Harst E Hofker S Nieuwenhuijs VB Brink MA Kruyt PM Manusama ER van der Schelling GP Karsten T Hesselink EJ van Laarhoven CJ Rosman C Bosscha K de Wit RJ Houdijk AP Cuesta MA Wahab PJ Gooszen HG;Dutch Pancreatitis Study Group 《Gastroenterology》2011,141(4):1254-1263
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Aafke H. van Dijk Philip R. de Reuver Marc G. Besselink Kees J. van Laarhoven Ewen M. Harrison Stephen J. Wigmore Tom J. Hugh Marja A. Boermeester 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):297-309
Background
Gallstone disease is a frequent disorder in the Western world with a prevalence of 10–20%. Recommendations for the assessment and management of gallstones vary internationally. The aim of this systematic review was to assess quality of guideline recommendations for treatment of gallstones.Methods
PubMed, EMBASE and websites of relevant associations were systematically searched. Guidelines without a critical appraisal of literature were excluded. Quality of guidelines was determined using the AGREE II instrument. Recommendations without consensus or with low level of evidence were considered to define problem areas and clinical research gaps.Results
Fourteen guidelines were included. Overall quality of guidelines was low, with a mean score of 57/100 (standard deviation 19). Five of 14 guidelines were considered suitable for use in clinical practice without modifications. Ten recommendations from all included guidelines were based on low level of evidence and subject to controversy. These included major topics, such as definition of symptomatic gallstones, indications for cholecystectomy and intraoperative cholangiography.Conclusion
Only five guidelines on gallstones are evidence-based and of a high quality, but even in these controversy exists on important topics. High quality evidence is needed in specific areas before an international guideline can be developed and endorsed worldwide. 相似文献40.
Cost‐effectiveness of same‐admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial
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