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  • Author: Kritaya Kritayakirana x
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Open access

Suvit Sriussadaporn, Sukanya Sriussadaporn, Rattaplee Pak-art, Kritaya Kritayakirana, Supparerk Prichayudh and Pasurachate Samorn

Abstract

Background

Hepatic resections conducted for malignant tumors can be difficult because of the need to create cancer-free margins.

Objectives

To examine the outcome of hepatic resections after the introduction of a Cavitron Ultrasonic Surgical Aspirator (CUSA).

Methods

A retrospective study of patients who underwent hepatic resection by a single surgeon between April 1999 to March 2013.

Results

We included 101 patients with 104 hepatectomies. Most hepatic parenchymal transections were performed using a CUSA under intermittent hepatic inflow occlusion (Pringle maneuver). Thirty-five patients underwent a right hepatectomy, 11 a left hepatectomy, 6 a right hepatectomy and segment I resection, 6 a right lobectomy, and 46 underwent segmentectomies, wedge resections, or other types of hepatic resections. Biliary-enteric reconstruction with a Roux-en-Y limb of the jejunum to a hepatic duct of the hepatic remnant was performed in 28 patients. Operative time was 90–720 min (median 300 min, mean 327 ± 149 min). Operative blood transfusion was 0–17 units (median 3 units, mean 3.9 ± 3.6 units). Twenty-one hepatectomies were conducted without blood transfusion. Thirty-four postoperative complications occurred in 30 patients with a 9% reoperation rate. Perioperative mortality was 6%. Age, operative time, operative blood transfusion, reoperation, and complications were significantly associated with mortality.

Conclusion

Careful preoperative diagnosis and evaluation of patients, faultless surgical techniques, and excellent postoperative care are important to avoid potentially serious postoperative complications and mortality. The CUSA is an effective assisting device during hepatic parenchymal transection with a concomitant Pringle maneuver, apparently reducing operative blood loss.

Open access

Suvit Sriussadaporn, Sukanya Sriussadaporn, Rattaplee Pak-art, Kritaya Kritayakirana, Supparerk Prichayudh and Pasurachate Samorn

Abstract

Background

Premalignant and malignant cystic neoplasms of the pancreas are relatively rare, but absolute indications for surgical resection. Modern imaging modalities have increased recognition of asymptomatic cysts resulting in therapeutic dilemmas of whether surgery or observation is appropriate.

Objectives

To examine our surgical experience with cystic neoplasms of the pancreas.

Methods

A retrospective study of patients who had cystic neoplasms of the pancreas and underwent surgical resections from June 2000 to April 2013. Presenting symptoms, surgical procedures, pathological diagnoses, and postoperative complications were analyzed.

Results

Data from 16 patients were examined. Two patients had asymptomatic cystic neoplasms. Fourteen had symptoms ranging from 2 days to 6 years before diagnosis and surgery. Six patients underwent pylorus preserving pancreaticoduodenectomy, 4 underwent distal pancreatectomy with splenectomy, 2 underwent splenic preserving distal pancreatectomy, and 1 each underwent a classical Whipple operation, total pancreatectomy, distal pancreatectomy with splenectomy with partial resection of the posterior gastric wall, and distal pancreatectomy with splenectomy with left colectomy. The operative time ranged from 150 to 450 minutes. Operative blood transfusion ranged from 0 to 5 units. Four patients had mucinous cystadenoma, 4 had intraductal papillary mucinous neoplasia with varying degree of dysplasia and carcinomatous changes, 6 had other malignancies, and 2 had other benign cysts. Postoperative complications occurred in 3 patients. There was no perioperative mortality.

Conclusion

Any suspicion of malignant changes in asymptomatic cysts should have them considered for surgical resection. Meticulous surgical techniques are important for pancreatic resection to minimize the occurrence of postoperative complications.

Open access

Supparerk Prichayudh, Kritaya Kritayakirana, Pasurachate Samorn, Rattaplee Pak-art, Sukanya Sriussadaporn, Suvit Sriussadaporn, Wilaiporn Kiatpadungkul, Kanthachat Thatsakorn and Ithiphon Viratanapanu

Abstract

Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation.

Objective: To study a BCI patient who underwent a successful operation using damage control principles.

Methods: We reviewed and analyzed the patient’s chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted.

Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient’s physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36.

Conclusion: In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.

Open access

Supparerk Prichayudh, Eakkaluck Thammacharoen, Suvit Sriussadaporn, Rattaplee Pak-art, Sukanya Sriussadaporn, Kritaya Kritayakirana, Pasurachate Samorn and Natawat Narueponjirakul

Abstract

Background

An enteroatmospheric fistula (EAF) is a devastating complication of abdominal surgery. EAF wound care is uniformly problematic and burdensome because the fistula effluent is difficult to contain, causing several abdominal skin problems.

Objectives

To report the case of a complex EAF in a patient in whom conventional wound care techniques failed to contain the fistula.

Methods

We reviewed the patient’s medical records and the novel wound care technique used to contain the fistula.

Results

We report the use of a modified vacuum-assisted closure (VAC) technique, the “Wall VAC”, for the wound care of a patient with a complex EAF having large and multiple fistula openings following multiple abdominal operations. The Wall VAC technique consists of (1) leveling the skin surrounding the EAF wound, (2) creating the Wall VAC using a rectangular-shaped VAC sponge with 2 suction systems, and (3) sealing the system with a plastic bag and incise drape. By using this technique, the fistula effluent was effectively contained and the abdominal skin was well protected. The system changed every 3 to 4 days.

Conclusions

Our modified VAC technique, the “Wall VAC”, is simple and effective in containing a large volume (3,000 to 4,000 mL) of fistula effluent and protecting the abdominal skin in a patient with a complex EAF. We recommend this particular technique as an alternative method for managing a complex EAF.