AIMTo investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.RESULTSTwenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter LOS than a contemporaneous PD series [PPDD 8 (6-14) d vs PD 11 (10-16) d, median (IQR), P = 0.026]. The 30-d mortality was zero and 16 of 19 patients are alive to date. One patient died of recurrent duodenal adenocarcinoma 18 mo postoperatively and two died of unrelated disease (at 2 mo and at 8 years respectively).CONCLUSIONPPDD is a versatile operation that can provide definitive treatment for a range of duodenal pathologies including adenocarcinoma.

Introduction Groove pancreatitis (GP) is a rare and focal form of pancreatitis affecting the para-duodenal groove area. Diagnosis is usually made by radiological imaging or histological analysis. This study aimed to determine the disease pattern, treatment modalities and outcomes. Methods Data were retrospectively collected for patients diagnosed with GP radiologically and/or histologically at our tertiary hospital from 2010 to 2019. A search of our imaging database was conducted using the term groove pancreatitis totalling 1,040 patients. Duplicates (95) and reports mentioning only groove or only pancreatitis (945) were eliminated. All included patients were then re-assessed by two expert hepatopancreaticobiliary radiologists and a specialist histopathologist to confirm inclusion. Results Our cohort comprised of 54 patients, 39 males and 15 females. The mean age was 67 years (range 39-101 years). Of the 54 patients, 11 had pancreatic cancer (20%). Pain as a main presenting complaint occurred in 78% and jaundice in only 13%. 26% had elevated lipase and 37% had deranged LFTs. 69% were managed conservatively as first line. 11% of patients failed conservative management and proceeded to endoscopic treatment. Surgical intervention occurred in 24%. 11% of all patients had complete symptom relief, and 76% showed symptom improvement. Mortality at 2years of follow-up, was 45% and 28% in those with and without cancer. Conclusion GP is a benign disease with a non-specific natural history. It remains unclear if there is a transition between GP and GP-associated mass. This emphasises a high index of suspicion in diagnosis, using radiological, endoscopic, and cytological analysis.

Background: Esophagectomy traditionally has high levels of perioperative morbidity and mortality due to the surgical techniques and case complexity. While thoracic epidural analgesia (TEA) is considered first-line for postoperative analgesia after esophagectomy, there can be complications related to its sympathectomy and mobility impairment. Additionally, it has been shown that postoperative outcomes are improved with early extubation following esophagectomy. Our aim is to describe the impact of transversus abdominus plane (TAP) blocks on extubation rates following esophagectomy when uncoupled from TEA. Methods: This is a retrospective study of 42 patients who underwent trans-hiatal esophagectomy between 2019 and 2022 who received a TAP block in the absence of TEA. The primary outcomes of interest were the rates of extubation within the operating room (OR) and reintubation. Secondary outcomes included: intensive care unit (ICU) and hospital length of stay (LOS), opioid pain medication use, time to enteral diet, reported postoperative pain scores, development of anastomotic leak, and 30-day readmission. Results: The mean age at operation was 63 years and 97.6% of patients were represented by American Society of Anesthesia (ASA) physical status class III or IV. 35 (83.3%) patients immediately extubated postoperatively. Nine patients (21.4%) underwent reintubation during their hospital course. Only six patients (14%) required vasopressors postoperatively. The median LOS was five days in the ICU and 10 days in the hospital. TAP block alone was found to be equivalent to TAP with additional regional blocks (TAP+) on the basis of immediate extubation, reintubation, ICU and hospital LOS, and reported postoperative pain. Conclusion: The results of this study demonstrate TAP blocks do provide comparable rates of successful immediate extubation and reintubation to TEA with fewer hypotensive complications after trans-hiatal esophagectomy. This was shown despite the elevated comorbidity burden of this study’s population. Additionally, TAP blocks maintained similar reported pain control scores to TEA literature.Overall, this study supports the use of TAP blocks as the primary analgesia in patients undergoing trans-hiatal esophagectomy over TEA. Trial Registration: This study includes participants who were retrospectively registered. IRB# 037.HPB.2018.R