Background Atrial fibrillation and delayed gastric emptying (DGE) are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7th postoperative day. Methods We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. Results Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005). Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p = 0.03). 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p = 0.0007). This association held true when controlling for age. Conclusion Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.
Laparoscopic adrenalectomy has largely replaced open adrenalectomy for resection of adrenal tumors, which are not adrenocortical cancer or malignant pheochromocytoma. Laparoscopic retroperitoneal adrenalectomy is a particularly useful technique in patients with tumors <7 cm and body mass index <45 kg/m2. When compared with laparoscopic transabdominal adrenalectomy, the laparoscopic retroperitoneal technique leads to reduced operating times, avoidance of intra-abdominal adhesions and irradiated fields, potentially less postoperative pain, and improved intraoperative hemostasis and visualization. The technique involves placement of 3 ports, dissecting the retroperitoneal space, identifying and ligating the adrenal vein, and removing the attachments to the adrenal gland. See the video, Supplemental Digital Content 1, https://links.lww.com/SLE/A38
