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  1. Article ; Online: The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection.

    Mownah, Omar A / Aroori, Somaiah

    Annals of hepato-biliary-pancreatic surgery

    2023  Volume 27, Issue 2, Page(s) 131–140

    Abstract: During minimally invasive liver resection (MILR), the Pringle maneuver aims to minimize blood loss and provide a clear operative field, thereby identifying intrahepatic structures and facilitating safe parenchymal transection. Several techniques for ... ...

    Abstract During minimally invasive liver resection (MILR), the Pringle maneuver aims to minimize blood loss and provide a clear operative field, thereby identifying intrahepatic structures and facilitating safe parenchymal transection. Several techniques for using the Pringle maneuver in MILR have been described. This review presents various methods which have been reported in the literature. A systematic literature search used the MEDLINE/PubMed database from its earliest records to August 2022 using appropriate search headings and keywords. The primary outcome was identifying techniques for performing hepatic inflow occlusion during laparoscopic/robotic hepatectomy. Inclusion criteria consisted of publications describing technical steps to obtain hepatic inflow occlusion during minimally invasive hepatectomy. A literature search identified 23 relevant publications, and the full texts were examined. The techniques described in the reports can be broadly categorized into three groups: (1) the Rummel-tourniquet technique, (2) vascular clamp use, and (3) the Huang Loop technique. Various techniques have been used in MILR to achieve inflow confinement successfully. The authors prefer the modified Huang Loop technique because it is inexpensive, reliable, and quick to apply or release. Hepatobiliary surgeons are advised to familiarize themselves with these MILR techniques, which have proven effective and safe inflow occlusion.
    Language English
    Publishing date 2023-03-06
    Publishing country Korea (South)
    Document type Journal Article ; Review
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.22-109
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Procedure-specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors.

    Russell, Thomas B / Aroori, Somaiah

    ANZ journal of surgery

    2022  Volume 92, Issue 6, Page(s) 1347–1355

    Abstract: Background: Pancreatoduodenectomy (PD) remains the only curative-intent treatment option for patients with cancer affecting the head of the pancreas. It is high-risk and overall morbidity is around 40%. Due to the necessary resection and subsequent ... ...

    Abstract Background: Pancreatoduodenectomy (PD) remains the only curative-intent treatment option for patients with cancer affecting the head of the pancreas. It is high-risk and overall morbidity is around 40%. Due to the necessary resection and subsequent anastomoses required, multiple procedure-specific complications are possible. An in-depth understanding of the recent evidence on these will guide the consenting process and allow surgeons to evaluate their own performance. We aimed to consolidate the recent literature on preselected PD complications (postoperative pancreatic fistula (POPF), bile leak (BL), gastrojejunal leak, postpancreatectomy haemorrhage (PPH), cholangitis, and chyle leak (CL)).
    Methods: A search of the PubMed database was carried out on 1st July 2021. Articles from July 2011 through to July 2021 were included. The initial search returned 297 results. After screening, 226 articles were excluded. The remaining 71 were assessed for eligibility and a further 34 were excluded. 37 were included in the final synthesis (two meta-analyses and 35 single/multicentre studies).
    Results: Due to recently updated diagnostic criteria, differing definitions among authors and subclinical cases, true incidence rates are difficult to appreciate. The following were obtained: POPF (excluding biochemical leak): 10.0-25.9%, BL: 3.0-7.9%, gastrojejunal anastomotic leak: 0.4-1.2%, PPH: 7.3-13.6%, cholangitis: 0.05-21.1% and CL: 2.6-19.0%. Numerous risk factors, both modifiable and non-modifiable, were identified for each.
    Conclusion: Most of the recent evidence on the studied complications comes from single institution studies of retrospective design. Robust case-control studies are required so predictive models can estimate the likelihood of specific complications in individual patients.
    MeSH term(s) Cholangitis/complications ; Humans ; Incidence ; Pancreatic Fistula/complications ; Pancreatic Fistula/etiology ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/methods ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2022-01-24
    Publishing country Australia
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.17473
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: An

    Russell, Thomas B / Ciprani, Debora / Aroori, Somaiah

    Annals of hepato-biliary-pancreatic surgery

    2023  Volume 27, Issue 4, Page(s) 423–427

    Abstract: Backgrounds/aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. ... ...

    Abstract Backgrounds/aims: Patients who undergo pancreatic surgery with venous resection have high rates of morbidity/mortality. Also, they are high-risk for postoperative venous thromboembolism. Whether this group should be routinely anticoagulated is unknown. This study aimed to establish current anticoagulation practices.
    Methods: A survey (https://form.jotform.com/220242489107048) was sent out to pancreatic surgeons. Questions covered center volume, venous resection/reconstruction techniques and anticoagulation policies.
    Results: Sixty-five centers from 17 countries responded. Following a "side-bite" venous resection with a patch repair, 40% used an autologous vein patch, 27% used peritoneum, and 27% used a bovine patch. After formally resecting a segment of vein, 17% of centers used an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (73%) grafts were the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a "side-bite" resection, 59%, 28%, and 19% of centers provided therapeutic anticoagulation, respectively (66% used low molecular-weight heparin). The duration of therapy provided varied from inpatient stay only (14%) to six months (32%).
    Conclusions: Our global survey indicates that anticoagulation practices are highly variable. Centers do not agree on when to anticoagulate, how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity.
    Language English
    Publishing date 2023-10-17
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.23-065
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Incidental double duct sign: Should we be worried? Results from a long-term follow-up study.

    Yao, Lu / Amar, Hoda / Aroori, Somaiah

    Annals of hepato-biliary-pancreatic surgery

    2023  Volume 28, Issue 1, Page(s) 53–58

    Abstract: Backgrounds/aims: Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of ... ...

    Abstract Backgrounds/aims: Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS.
    Methods: Patients were categorized according to their risk of malignancy. 'Low-risk' patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS.
    Results: Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for 'low-risk' patients was 7.3 years (range, 6-11 years). The mean number of follow-up investigations per patient was two (range, 0-9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (
    Conclusions: Patients with I-DDS have a low risk of developing PHPAT within five years.
    Language English
    Publishing date 2023-11-02
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.23-063
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Role of Colour Segmented Fluorescence (CSF) Mode and Same-day Administration of Low-dose Indocyanine Green in Liver Surgery: Our Initial Experience : Indocyanine Green Fluorescence Guided Resection of Liver Tumours.

    Karmarkar, Rahi / Benjafield, Anastasia / Aroori, Somaiah

    Journal of fluorescence

    2023  

    Abstract: Indocyanine green (ICG) fluorescence image guidance (I-FIGS) is increasingly used in liver surgery. Several regimens have been described regarding the optimum timing and dose of administration. This study presents our early experience with utilising ... ...

    Abstract Indocyanine green (ICG) fluorescence image guidance (I-FIGS) is increasingly used in liver surgery. Several regimens have been described regarding the optimum timing and dose of administration. This study presents our early experience with utilising monochromatic Colour Segmented Fluorescence (CSF)-mode and same-day administration of low-dose-ICG in the resection of liver tumours. Between November 2020 and March 2022, I-FIGS was used in 15 patients with suspected liver tumours. ICG was administered intravenously at 0.02 to 0.05 mg/kg dose 2-3 h before surgery. ICG camera was switched to CSF-grey-scale mode to visualise the tumour and to avoid the interference of the green background liver. Using the SPY-CSF mode, the image was scaled to near-infra-red (NIR) fluorescence intensity to accurately identify the tumours and resection margins. Fifteen patients (eight males) with a median age of 71 years (range: 36-86) underwent I-FIGS. Of these, 67% underwent laparoscopic liver surgery, 78% had non-anatomical resections, and 33% underwent redo liver surgery. The mean tumour size was 40.6 mm (SD+/-41 mm). The median number of tumours was two (1-7). All colorectal liver metastases (CRLM) had a signet ring appearance. Hepatocellular carcinomas (HCC) showed partial fluorescence. Tumours were well/moderately differentiated, with CRLM in 86% and HCC in two patients. The R0 resection rate was 72%. In our experience, low-dose-ICG administered at least 2-3 h before surgery can identify liver tumours and their margins in CSF-grey-scale mode. Further research is needed to evaluate its role in reducing R1 resection rates and surgical outcomes.
    Language English
    Publishing date 2023-09-15
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2016892-5
    ISSN 1573-4994 ; 1053-0509
    ISSN (online) 1573-4994
    ISSN 1053-0509
    DOI 10.1007/s10895-023-03434-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Expanding the definition of covid-19 deaths will show the true effect of the pandemic.

    Labib, Peter L / Aroori, Somaiah

    BMJ (Clinical research ed.)

    2020  Volume 369, Page(s) m2153

    Keywords covid19
    Language English
    Publishing date 2020-05-29
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.m2153
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: How we do it: Laparoscopic cholecystectomy in patients with severe obesity.

    Russell, Thomas B / Aroori, Somaiah

    Turkish journal of surgery

    2021  Volume 37, Issue 4, Page(s) 413–416

    Abstract: The number of patients with obesity is set to rise, as is the proportion with severe obesity. These patients are a high-risk subgroup who present addi- tional challenges to the surgeon when performing laparoscopic cholecystectomy. It is important that ... ...

    Abstract The number of patients with obesity is set to rise, as is the proportion with severe obesity. These patients are a high-risk subgroup who present addi- tional challenges to the surgeon when performing laparoscopic cholecystectomy. It is important that all surgeons who perform this procedure have a safe strategy they can revert to. This article outlines our approach. After obtaining pneumoperitoneum via a supra-umbilical incision, we advise placing a fascial suture before proceeding with the operation. This allows for high-quality closure, reduces the incidence of incisional hernia, and reduces the risk of inadvertent bowel injury. We also advise the repositioning of the patient on the operating table prior to port placement such that an ergonomic set-up can be achieved. In addition to standard ports, we use an additional twelve-millimetre port in the left upper quadrant. A fan retractor can be inserted via this port and used to gently retract the duodenum inferiorly. This provides adequate exposure for Calot's dissection and arguably reduces the risk of injury to a fatty liver. This technique can also be used in non-obese patients in whom Calot's dissection is particularly challenging, for instance in those who undergo delayed cholecystectomy.
    Language English
    Publishing date 2021-12-31
    Publishing country Turkey
    Document type Journal Article
    ISSN 2564-6850
    ISSN 2564-6850
    DOI 10.47717/turkjsurg.2021.5452
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Intraoperative ultrasound versus fluorescence and X-ray cholangiography for the identification of bile duct stones, biliary anatomy and bile duct injury during laparoscopic cholecystectomy: Time for a randomized controlled trial?

    Labib, Peter L / Aroori, Somaiah

    The British journal of surgery

    2020  Volume 107, Issue 11, Page(s) e563

    MeSH term(s) Bile Ducts/diagnostic imaging ; Bile Ducts/injuries ; Cholangiography/methods ; Cholecystectomy, Laparoscopic/methods ; Cholelithiasis/diagnostic imaging ; Cholelithiasis/surgery ; Humans ; Optical Imaging ; Randomized Controlled Trials as Topic ; Ultrasonography, Interventional/methods
    Language English
    Publishing date 2020-08-25
    Publishing country England
    Document type Letter
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11862
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  9. Article ; Online: Five-year follow-up after pancreatoduodenectomy performed for malignancy: A single-centre study.

    Russell, Thomas Brendon / Labib, Peter Lawrence Zaki / Aroori, Somaiah

    Annals of hepato-biliary-pancreatic surgery

    2022  Volume 27, Issue 1, Page(s) 76–86

    Abstract: Backgrounds/aims: The aim of this study was to describe short- and long-term outcomes of patients who underwent pancreatoduodenectomy (PD) at a typical United Kingdom hepatopancreatobiliary unit.: Methods: A retrospective analysis of all PD patients ... ...

    Abstract Backgrounds/aims: The aim of this study was to describe short- and long-term outcomes of patients who underwent pancreatoduodenectomy (PD) at a typical United Kingdom hepatopancreatobiliary unit.
    Methods: A retrospective analysis of all PD patients with histologically-confirmed pancreatic ductal adenocarcinoma (PDAC), ampullary adenocarcinoma (AA), or distal cholangiocarcinoma (CC) from September 1st, 2006 to May 31st, 2015 was carried out. The following information was obtained: demographics, comorbidities, preoperative investigations, neoadjuvant treatment, operative details, postoperative management, complications, adjuvant treatment, five-year recurrence, and five-year survival. Effects of selected preoperative variables on short- and long-term outcomes were investigated.
    Results: Of 271 included patients, 57.9% had PDAC, 25.8% had AA, and 16.2% had CC. In total, 67.9% experienced morbidity and 17.3% developed a Clavien-Dindo grade ≥ III complication. The 90-day mortality was 3.3%. Clinically-relevant postoperative pancreatic fistula, bile leak, gastrojejunal leak, postpancreatectomy haemorrhage and delayed gastric emptying affected 8.1%, 4.1%, 0.0%, 9.2%, and 19.9% of patients, respectively. American Society of Anesthesiologists grade III-VI correlated with overall morbidity (
    Conclusions: In our series, the majority of patients experienced a complication. However, few patients experienced major morbidity. Surgical risk factors did not affect five-year survival.
    Language English
    Publishing date 2022-09-28
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.22-039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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