Postoperative pancreatic fistula (POPF) is the most common major complication after pancreatoduodenectomy (PD) and it can lead to prolonged hospital stay, increased costs, and mortality. The POPF rate is strictly correlated to the definition applied, but there are so many different definitions in the literature that comparison between published series of patients is difficult. The International Study Group of Pancreatic Fistula (IGSPF) has developed a new definition, with a grading system able to stratify complicated patients into three groups, based upon the clinical implications and costs of their postoperative course. The most important risk factors identified are a soft pancreatic texture and a main pancreatic duct diameter of 3 mm or less. Several surgical techniques have been studied in order to prevent anastomotic leakage, but none has been demonstrated to be superior to others. The use of somatostatin analogues is still matter of controversy. Conservative management of POPF is usually effective, but in patients with deteriorating clinical status with evidence of sepsis, surgical management is needed.

Aim: Several new irreversible hydrocolloid formulations have recently become available with claims of an improved dimensional stability by the manufacturers. The aim of this study was to evaluate the accuracy of casts made from alginate impression materials poured immediately and after specific storage periods. Methods and Materials:Five alginates were tested: CA 37 (Cavex); Jeltrate (Dentsply Caulk); Jeltrate Plus (Dentsply Latin America); Hydrogum 5 (Zhermack); and Alginoplast (Heraeus Kulzer). A master model was mounted on a special device and used to obtain the impressions. These impressions were stored at 23°C and 100% relative humidity, then poured with gypsum immediately, and again after 24, 72 and 120 hours. The casts were measured and the data were analyzed by one way analysis of variance (ANOVA) and Tukey test at p<0.05. Results:The dimensional stability of the alginate impressions was both material and time dependent (p<0.05). After 24 hours of storage, only Alginoplast and Hydrogum 5 comply with the master model (p>0.05). After 72 and 120 hours, only Hydrogum 5 was dimensionally stable (p>0.05). Conclusion:The dimensional stability of the alginate impressions is influenced by the selected material and the storage time. Abstract © Seer PublishingClinical Significance: Alginate impressions should generally be poured immediately. However, some new types of alginate may have the pouring delayed. Citation: Sedda M, Casarotto A, Raustia A, Borracchini A. Effect of Storage Time on the Accuracy of Casts Made from Different Irreversible Hydrocolloids. J Contemp Dent Pract 2008 May; (9)4:059-066.

According to the present findings, the development of postoperative complications may be an additional prognostic factor after potentially curative pancreaticoduodenectomy for primary duodenal adenocarcinoma. This emphasizes the need for centralization to high-volume centers where an appropriate postoperative care can be delivered.

LAs are not associated with a lower complication rate than the OAs and, above all, LAs are more expensive than OAs. Also we believe that laparoscopic approach should be used only in case of unclear abdominal pain and not for the treatment of clear acute and uncomplicated appendicitis.

No abstract