AIM To compare laparoscopic pancreaticoduodenectomy（TLPD） during the initial learning curve withopen pancreaticoduodenectomy in terms of outcomeand costs.METHODS： This is a retrospective review of theconsecutive patients who underwent TLPD betweenDecember 2009 and April 2014 at our institution. Theexperiences of the initial 15 consecutive TLPD cases,considered as the initial learning curve of each surgeon,were compared with the same number of consecutivelaparotomy cases with the same spectrum of diseasesin terms of outcome and costs. Laparoscopic patientswith conversion to open surgery were excluded.Preoperative demographic and comorbidity data wereobtained. Postoperative data on intestinal movement,pain score, mortality, complications, and costs wereobtained for analysis. Complications related to surgeryincluded pneumonia, intra-abdominal abscess,postpancreatectomy hemorrhage, biliary leak, pancreaticfistula, delayed gastric emptying, and multiple organdysfunction syndrome. The total costs consisted of costof surgery, anesthesia, and admission examination.RESULTS： A total of 60 patients, including 30consecutive laparoscopic cases and 30 consecutiveopen cases, were enrolled for review. Demographicand comorbidity characteristics of the two groups weresimilar. TLPD required a significantly longer operativetime （513.17 ± 56.13 min vs 371.67 ± 85.53 min, P 〈0.001）. The TLPD group had significantly fewer meannumbers of days until bowel sounds returned （2.03 ±0.55 d vs 3.83 ± 0.59 d, P 〈 0.001） and exhaustion（4.17 ± 0.75 d vs 5.37 ± 0.81 d, P 〈 0.001）. The meanvisual analogue score on postoperative day 4 wasless in the TLPD group （3.5 ± 9.7 vs 4.47 ± 1.11, P〈 0.05）. No differences in surgery-related morbiditiesand mortality were observed between the two groups.Patients in the TLPD group recovered more quickly andrequired a shorter hospital stay after surgery （9.97± 3.74 d vs 11.87 ± 4.72 d, P 〈 0.05）. A significantdifference in the total cost was found between the twogrou
A patient with stent embedding after placement of an esophageal stent for an esophagobronchial fistula was treated with an ST-E plastic tube inserted into the esophagus to the upper end of the stent using gastroscopy.The gastroscope was guided into the esophagus through the ST-E tube,and an alligator forceps was inserted into the esophagus through the ST-E tube alongside the gastroscope.Under gastroscopy,the stent wire was grasped with the forceps and pulled into the ST-E tube.When resistance was met during withdrawal,the gastroscope was guided further to the esophageal section where the stent was embedded.Biopsy forceps were guided through a biopsy hole in the gastroscope to the embedded stent to remove silicone membranes and connection threads linking the Z-shaped wire mesh.While the lower section of the Z-shaped stent was fixed by the biopsy forceps,the alligator forceps were used to pull the upper section of the metal wire until the Z-shaped metal loops elongated.The wire mesh of the stent was then removed in stages through the ST-E tube.Care was taken to avoid bleeding and perforation.Under the assistance of an ST-E plastic tube,an embedded esophageal metal stent was successfully removed with no bleeding or perforation.The patient experienced an uneventful recovery after surgery.Plastic tube-assisted gastroscopic removal of embedded metal stents can be minimally invasive,safe,and effective.
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