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To assess the association between perianastomotic fluid collection (PFC) during the early postoperative period and postoperative pancreatic fistula (POPF) related complications, and to investigate the optical drain location. Methods: Medical records of 148 patients who had undergone PD and computed tomography (CT) on postoperative day 4 were retrospectively reviewed. The locationdsuperior, inferior, ventral, dorsal, or splenic hilumdand volume of PFC were determined using CT. Postoperative complications were compared between the PFC and non-PFC groups. Association between volume and postoperative complications was assessed. Results: The PFC group included 102 patients (69%). POPF and organ/space surgical site infection (SSI) were more frequent in the PFC group (p < 0.001 and p=0.020, respectively). According to the location of PFC, superior and ventral PFCs were associated with pseudoaneurysm (p=0.006 and p=0.002, respectively), while inferior and dorsal PFCs were associated with deep incisional SSI (p=0.027 and p=0.034, respectively). In 5 of 9 patients with inferior PFC and deep incisional SSI, the PFC had reached the abdominal wall via the surface of the transverse mesocolon. All of these patients showed a dorsal PFC connected to the inferior PFC on CT performed on POD 4. Therefore, we added drainage tube at the inferior part of PJ for soft pancreas cases after January 2019. We encountered clinically relevant POPF in 3 cases of 10 soft pancreas cases, however we did not experience deep incisional SSI. Conclusion:The prevention of PFC during the early postoperative period may prevent more severe POPF related complications.

Background: The aim of this study was to evaluate whether our standardized procedure with mesh-reinforced stapler (Endo-GIA TM with Tri-Staple TM technology; black reload; 60-m long; Covidien) can reduce the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy. Methods: A total of 60 patients underwent mesh-reinforced stapled distal pancreatectomy at our institute from July 2016 to November 2019. Laparoscopic distal pancreatectomy was performed in 43 (71.7%) patients. The incidence of clinically relevant POPF (grade B or C based on the International Study Group on Pancreatic Fistula criteria) was retrospectively analyzed. Surgical procedures: The pancreatic parenchyma was transected by stapler on the transection line with safety margin from the lesion. The closure jaw was carefully clamped over a 1-min period at a fixed speed. The stapler was slowly fired over a 6-min period and then released. Careful, gentle handling of the stapler was required during transection of the pancreatic parenchyma. A closed-suction drain was always placed near the stump of the remnant pancreas. Results: The median operative time was 274min (133-585), and median operative blood loss was 170g (1-2519). The incidence of clinically relevant POPF occurred in 4 patients (6.7%). We have never experienced POPF grade C. The major morbidity rate (Clavien-Dindo classification grade III) occurred in 7 patients (15%). Complications other than POPF grade B occurred in 3 patients (ileus, n=2; delayed gastric emptying, n=1). No surgical mortality or inhospital death occurred in this study. Conclusions: Our standardized technique with mesh-reinforced stapler can reduce clinically relevant POPF after distal pancreatectomy.

Introduction: Portal hypertension (PHT) commonly accompanies cirrhosis of liver. Development of esophageal varices is one of the major complications of PHT. A major cause of PHT-related morbidity and mortality is the development of variceal hemorrhage, which occurs in 25-40% of patients. 1 Esophageal varices are diagnosed by endoscopy. Further follow-up should then relate to the initial size of varices. In case of large varices, endoscopic follow-up is not necessary and primary prophylaxis with a nonselective β-blocker should be started. Endoscopic band ligation is useful in preventing variceal bleeding in patients with medium or large varices. The present study was conducted to assess the clinical presentation of cases of portal hypertension presented with esophageal varices in tertiary healthcare institute. Material and methods:The present study was conducted at a tertiary healthcare teaching institute from July 2018 to October 2018 and 70 patients were studied. All the cases presented with PHT, which had been diagnosed clinically, biochemically, radiologically and endoscopically were included in the present study. Results: Incidence of esophageal varices in patients withPHT is approximately 90-95%, but only 30-50% develop variceal bleeding, which is usually associated mainly with fatal outcome. Pallor (88%), ascites (80%) and splenomegaly (70%) were common signs followed by icterus (52%). Asymptomatic esophageal varices were found in 80% of patients, 20% had Grade 1, 26% had Grade 2 and 34% had Grade 3 esophageal varices. Conclusions:Portal hypertension is largely a preventable condition because the commonest etiology is alcoholism. Asymptomatic esophageal varices, which is quite common, can be easily diagnosed with invasive endoscopy or otherwise suspected with noninvasive platelet/spleen size ratio in country like ours, where financial constraint is a main problem. It can be very useful and applicable at small centers like community health centers (CHCs) and primary health centers (PHCs) in our country with limited resources.