Background: Pancreatectomy after neoadjuvant therapy in patients without disease progression is t... more Background: Pancreatectomy after neoadjuvant therapy in patients without disease progression is the standard treatment for borderline pancreatic cancer; however, no national series have been published to date. Objective: The aim of this study is to evaluate morbidity and mortality of patients with borderline resectable pancreatic cancer undergoing pancreatectomy after neoadjuvant therapy. Material and methods: A total of 15 patients treated between 2011 and 2018 were analyzed. The epidemiologic data, type of neodajuvant therapy, radiological evaluation of the response to neoadjuvant therapy, morbidity, mortality and survival were evaluated. These 15 patients who underwent pancreatectomy after neoadjuvant therapy were compared with 15 pancreatectomized patients without previous neoadjuvant therapy. Results: Mean age was 66.5 years and 8 patients were men. The most common neoadjuvant therapy regimens were FOLFIRINOX (n = 6) and gemcitabine/paclitaxel (n = 5); 8 patients required addit...
Objective: To develop a new classification of acute pancreatitis severity on the basis of a sound... more Objective: To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. Background: The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity. Methods: A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. Result: The new classification of severity is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical. Conclusions: This classification is the result of a consultative process amongst pancreatologists from 49 countries. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research.
Difficult common bile duct stones Antecedentes: el manejo laparoscópico en un tiempo de la coledo... more Difficult common bile duct stones Antecedentes: el manejo laparoscópico en un tiempo de la coledocolitiasis se acompaña de una tasa de éxito elevada en la mayoría de los casos. Una excepción a esto son los cálculos coledocianos dificultosos. Objetivo: describir los resultados del manejo de cálculos coledocianos dificultosos. Material y métodos: revisión retrospectiva de una serie consecutiva de casos de cálculos coledocianos dificultosos tratados durante el período 2018-2020. Resultados: 8 pacientes cumplieron con el criterio de inclusión. El manejo en un tiempo por videolaparoscopia (5 casos) tuvo un 60% de conversión a cirugía abierta. Los otros pacientes (3 casos) fueron manejados inicialmente con endoscopia biliar por colangitis grave y fueron resueltos luego en forma electiva por instrumentación transcística. Conclusión: esta experiencia inicial sugiere que el abordaje en dos tiempos podría favorecer la resolución mininvasiva de los cálculos coledocianos dificultosos.
Introducción. En la actualidad existen controversias sobre la mejor estrategia para el alivio del... more Introducción. En la actualidad existen controversias sobre la mejor estrategia para el alivio del dolor en la pancreatitis crónica refractaria a los analgésicos. Objetivo. El objetivo de este trabajo fue el de evaluar los resultados de la operación de Frey para el tratamiento quirúrgico del dolor. Material y métodos. Entre junio de 1995 y junio de 2019 se incluyeron los pacientes operados mediante la cirugía de Frey. Se evaluaron las características morfológicas del páncreas mediante tomografía y/o resonancia nuclear magnética, la función endócrina y exocrina previa a la cirugía, así como los resultados inmediatos (morbilidad y mortalidad operatoria) y alejados (alivio del dolor e insuficiencia pancreática). Se realizó un análisis retrospectivo de una base de datos prospectiva. Resultados. Se realizaron 59 operaciones de Frey (8mujeres y 51 hombres). La edad promedio fue de 38,75 años (rango 32-57). Todos los pacientes tenían masa cefálica y un conducto de Wirsung mayor de 6 mm en l...
Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is ass... more Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule. Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones. Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020. Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation. Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive app...
Background: The COVID-19 pandemic has introduced dramatic changes in the health system. Elective ... more Background: The COVID-19 pandemic has introduced dramatic changes in the health system. Elective surgeries are the surgical activities with greater decline during the pandemic. Objective: The aim of this paper is to analyze the impact of the COVID-19 pandemic in pancreatic surgery in a public and a private institution. The number of surgeries performed in each institution was compared with those performed in same period of the previous year. Material and methods: Data from a prospective database of all the patients who underwent pancreatic surgery between March 10, 2020, and June 3, 2020, were analyzed. The epidemiological data, type of pancreatic resection, pathology diagnosis, morbidity and mortality were determined in each institution and compared with patients who underwent pancreatic surgery in both institutions between March 3, 2019, and June 24, 2019. Results: 23 pancreatic resections were performed during the pandemic (13 cephalic pancreaticoduodenectomies, 9 left pancreatec...
Antecedentes: Los pacientes con obstruccion duodenal tardia por tumor de pancreas irresecable req... more Antecedentes: Los pacientes con obstruccion duodenal tardia por tumor de pancreas irresecable requieren algun tipo de paliacion, ya sea endoscopica o quirurgica. Objetivo: Presentar nuestra experiencia con la gastroenteroanastomosis videopaparoscopica como metodo paliativo en el tratamiento de la obstruccion duodenal tardia. Lugar de aplicacion: Centro Terciario de Referencia. Diseno: Retrospectivo. Poblacion: Pacientes con obstruccion duodenal tardia por tumor de pancreas irresecable. Metodo: Mediante un analisis retrospectivo de una base de datos se analizaron los resultados de la gastroenteroanastomosis videolaparoscopica para el tratamiento de la obstruccion duodenal. Resultados: veinticuatro pacientes fueron tratados con gastroenteroanastomosis laparoscopica, veintidos de estos 24 pacientes tuvieron una supervivencia entre 2 y 4 meses. Cuatro enfermos (16%) presentaron retardo del vaciamiento gastrico, recibiendo tratamiento medico 2 pacientes y tratamiento quirurgico los otros...
Background: The prevalence of common bile duct stones associated with cholelithiasis increases wi... more Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithias...
Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complic... more Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience (APPRENTICE), an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results Of 1233 acute pancreatitis patients included in the study, 160 (13%) ex...
Objectives Because infected pancreatic necrosis (IPN) has multiple presentations, not all patient... more Objectives Because infected pancreatic necrosis (IPN) has multiple presentations, not all patients are likely to benefit from the same first-line treatment. Our objective was to evaluate morbidity and mortality in a series of patients treated with a multimodal therapeutic approach. Methods Between May 2012 and May 2019, 51 patients diagnosed with IPN were treated. The 5 initial treatment alternatives were as follows: percutaneous drainage, minimally invasive necrosectomy, antibiotics alone, transgastric necrosectomy, and temporizing percutaneous/endoscopic drainage. Initial treatment selection depended on evolution, clinical condition, and extension of pancreatic necrosis. Success, morbidity, and mortality rates were determined. Results In terms of determinant-based classification, 37 were classified as severe, and 14 as critical. Percutaneous, temporizing drainage, minimally invasive necrosectomy, antibiotics alone and transgastric necrosectomy approaches were used in 21, 10, 11, 4, and 5 patients, respectively. Necrosectomy was not required in 18 patients (35%). There were no significant differences in mortality among the different treatment approaches (P < 0.45). Overall success, morbidity, and mortality rates were 68.6%, 52.9%, and 7.8%, respectively. Conclusions The multimodal approach seems to be a rational and efficient strategy for the initial treatment of IPN.
Background: Pancreatectomy after neoadjuvant therapy in patients without disease progression is t... more Background: Pancreatectomy after neoadjuvant therapy in patients without disease progression is the standard treatment for borderline pancreatic cancer; however, no national series have been published to date. Objective: The aim of this study is to evaluate morbidity and mortality of patients with borderline resectable pancreatic cancer undergoing pancreatectomy after neoadjuvant therapy. Material and methods: A total of 15 patients treated between 2011 and 2018 were analyzed. The epidemiologic data, type of neodajuvant therapy, radiological evaluation of the response to neoadjuvant therapy, morbidity, mortality and survival were evaluated. These 15 patients who underwent pancreatectomy after neoadjuvant therapy were compared with 15 pancreatectomized patients without previous neoadjuvant therapy. Results: Mean age was 66.5 years and 8 patients were men. The most common neoadjuvant therapy regimens were FOLFIRINOX (n = 6) and gemcitabine/paclitaxel (n = 5); 8 patients required addit...
Objective: To develop a new classification of acute pancreatitis severity on the basis of a sound... more Objective: To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. Background: The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity. Methods: A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. Result: The new classification of severity is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical. Conclusions: This classification is the result of a consultative process amongst pancreatologists from 49 countries. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research.
Difficult common bile duct stones Antecedentes: el manejo laparoscópico en un tiempo de la coledo... more Difficult common bile duct stones Antecedentes: el manejo laparoscópico en un tiempo de la coledocolitiasis se acompaña de una tasa de éxito elevada en la mayoría de los casos. Una excepción a esto son los cálculos coledocianos dificultosos. Objetivo: describir los resultados del manejo de cálculos coledocianos dificultosos. Material y métodos: revisión retrospectiva de una serie consecutiva de casos de cálculos coledocianos dificultosos tratados durante el período 2018-2020. Resultados: 8 pacientes cumplieron con el criterio de inclusión. El manejo en un tiempo por videolaparoscopia (5 casos) tuvo un 60% de conversión a cirugía abierta. Los otros pacientes (3 casos) fueron manejados inicialmente con endoscopia biliar por colangitis grave y fueron resueltos luego en forma electiva por instrumentación transcística. Conclusión: esta experiencia inicial sugiere que el abordaje en dos tiempos podría favorecer la resolución mininvasiva de los cálculos coledocianos dificultosos.
Introducción. En la actualidad existen controversias sobre la mejor estrategia para el alivio del... more Introducción. En la actualidad existen controversias sobre la mejor estrategia para el alivio del dolor en la pancreatitis crónica refractaria a los analgésicos. Objetivo. El objetivo de este trabajo fue el de evaluar los resultados de la operación de Frey para el tratamiento quirúrgico del dolor. Material y métodos. Entre junio de 1995 y junio de 2019 se incluyeron los pacientes operados mediante la cirugía de Frey. Se evaluaron las características morfológicas del páncreas mediante tomografía y/o resonancia nuclear magnética, la función endócrina y exocrina previa a la cirugía, así como los resultados inmediatos (morbilidad y mortalidad operatoria) y alejados (alivio del dolor e insuficiencia pancreática). Se realizó un análisis retrospectivo de una base de datos prospectiva. Resultados. Se realizaron 59 operaciones de Frey (8mujeres y 51 hombres). La edad promedio fue de 38,75 años (rango 32-57). Todos los pacientes tenían masa cefálica y un conducto de Wirsung mayor de 6 mm en l...
Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is ass... more Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule. Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones. Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020. Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation. Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive app...
Background: The COVID-19 pandemic has introduced dramatic changes in the health system. Elective ... more Background: The COVID-19 pandemic has introduced dramatic changes in the health system. Elective surgeries are the surgical activities with greater decline during the pandemic. Objective: The aim of this paper is to analyze the impact of the COVID-19 pandemic in pancreatic surgery in a public and a private institution. The number of surgeries performed in each institution was compared with those performed in same period of the previous year. Material and methods: Data from a prospective database of all the patients who underwent pancreatic surgery between March 10, 2020, and June 3, 2020, were analyzed. The epidemiological data, type of pancreatic resection, pathology diagnosis, morbidity and mortality were determined in each institution and compared with patients who underwent pancreatic surgery in both institutions between March 3, 2019, and June 24, 2019. Results: 23 pancreatic resections were performed during the pandemic (13 cephalic pancreaticoduodenectomies, 9 left pancreatec...
Antecedentes: Los pacientes con obstruccion duodenal tardia por tumor de pancreas irresecable req... more Antecedentes: Los pacientes con obstruccion duodenal tardia por tumor de pancreas irresecable requieren algun tipo de paliacion, ya sea endoscopica o quirurgica. Objetivo: Presentar nuestra experiencia con la gastroenteroanastomosis videopaparoscopica como metodo paliativo en el tratamiento de la obstruccion duodenal tardia. Lugar de aplicacion: Centro Terciario de Referencia. Diseno: Retrospectivo. Poblacion: Pacientes con obstruccion duodenal tardia por tumor de pancreas irresecable. Metodo: Mediante un analisis retrospectivo de una base de datos se analizaron los resultados de la gastroenteroanastomosis videolaparoscopica para el tratamiento de la obstruccion duodenal. Resultados: veinticuatro pacientes fueron tratados con gastroenteroanastomosis laparoscopica, veintidos de estos 24 pacientes tuvieron una supervivencia entre 2 y 4 meses. Cuatro enfermos (16%) presentaron retardo del vaciamiento gastrico, recibiendo tratamiento medico 2 pacientes y tratamiento quirurgico los otros...
Background: The prevalence of common bile duct stones associated with cholelithiasis increases wi... more Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithias...
Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complic... more Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience (APPRENTICE), an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results Of 1233 acute pancreatitis patients included in the study, 160 (13%) ex...
Objectives Because infected pancreatic necrosis (IPN) has multiple presentations, not all patient... more Objectives Because infected pancreatic necrosis (IPN) has multiple presentations, not all patients are likely to benefit from the same first-line treatment. Our objective was to evaluate morbidity and mortality in a series of patients treated with a multimodal therapeutic approach. Methods Between May 2012 and May 2019, 51 patients diagnosed with IPN were treated. The 5 initial treatment alternatives were as follows: percutaneous drainage, minimally invasive necrosectomy, antibiotics alone, transgastric necrosectomy, and temporizing percutaneous/endoscopic drainage. Initial treatment selection depended on evolution, clinical condition, and extension of pancreatic necrosis. Success, morbidity, and mortality rates were determined. Results In terms of determinant-based classification, 37 were classified as severe, and 14 as critical. Percutaneous, temporizing drainage, minimally invasive necrosectomy, antibiotics alone and transgastric necrosectomy approaches were used in 21, 10, 11, 4, and 5 patients, respectively. Necrosectomy was not required in 18 patients (35%). There were no significant differences in mortality among the different treatment approaches (P < 0.45). Overall success, morbidity, and mortality rates were 68.6%, 52.9%, and 7.8%, respectively. Conclusions The multimodal approach seems to be a rational and efficient strategy for the initial treatment of IPN.
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Papers by Carlos Ocampo