Introduction: Obesity is thought to be associated with increased risk of postoperative complications. This study aims to evaluate the effect of body mass index (BMI) on pancreatic fistula, postoperative complications and its associated overall cost following pancreaticoduodenectomy. Methods: This is a cohort of patients undergoing pancreaticoduodenectomy from 2009–2014 at a high volume institution. Risks factors associated with postoperative complications and pancreatic fistula (POPF defined by the International Study Group) were evaluated by univariable and multivariable analyses. Hospitalization and emergency room costs up to 90 days following surgery were analyzed. Results: The median BMI of all patients (n = 276) was 26.2 (range = 16.6–48.4); higher for those with POPF, 27.85 (range = 16.7–44.4) vs. 25.88 (range = 16.7–48.4), P = 0.069. Similarly, the median BMI for those with a postoperative complication was higher, 26.7 (range = 16.7–43.9) vs. 25.18 (range = 17.56–48.44), P = 0.017. Overweight (BMI > 25 Kg/m2) and obese patients (BMI≥30 Kg/m2) had a higher rate of pancreatic fistula, 9.8% vs. 18.9%, P = 0.044 and 13.1 vs. 22.4%, P = 0.07, respectively; as well as postoperative complications, 42.2% vs. 55%, P = 0.040 and 47.5% vs. 59.7%, P = 0.084. In the multivariable analyses, higher BMI was associated with a higher risk of pancreatic fistula (OR: 2.31, 95% CI: 1.30–4.09) and postoperative complications (OR: 1.08, 1.03–1.14). The costs for hospitalizations and emergency room visits were higher for overweight (CAN$22, 901 vs. CAN$21,476, P = 0.046) and obese patients (CAN$24, 935 vs. CAN$22,113, P = 0.056). Conclusions: Higher BMI is associated with higher risk of pancreatic fistula and overall morbidity, which significantly increases the cost of caring for patients following pancreaticoduodenectomy.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain control following pancreaticoduodenectomy. They are, however, thought to increase postoperative leak rate after certain types of intra-abdominal operations like colorectal surgery. This study aims to evaluate the association between perioperative NSAIDs use and postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy. Methods: This is a retrospective review of patients undergoing pancreaticoduodenectomy from January 2009 to March 2014. Risks factors for POPF, including use of NSAIDS, were evaluated using univariable and multivariable methods. Results: There were 276 patients analyzed during the study period (150/276, 54% of which had a diagnosis of pancreatic adenocarcinoma). At least one dose of NSAIDs was administered in 82 (29.7%) patients. Ketorolac was the most common type of NSAIDs used (72/82, 87.8%). There were 43/276 (16%) POPF events in the cohort, 13/276 (4.7%) of which were clinically relevant pancreatic fistulas (ISGPF type B or C). NSAIDs use was not associated with a significant increase in the risk of POPF (OR: 1.33 95% confidence interval=0.67–2.64, P=0.444). There was also no correlation found between the type, the number of days or the postoperative day NSAIDs were used and the risk of POPF. The most important factor associated with POPF was disease pathologies other than pancreatic adenocarcinoma or chronic pancreatitis. Conclusions: This study suggests that there is no association between the use of postoperative NSAIDs and the risk of POPF. Further studies are needed to better understand the implications of NSAIDs use and postoperative complications.

Background: Decision making on the competency of surgical trainees to perform laparoscopic procedures has been hampered by the lack of reliable methods to evaluate operative performance. The goal of this study was to develop a feasible and reliable method of evaluation.Methods: Twenty-nine senior surgical residents were videotaped performing a low anterior resection and a Nissen fundoplication in a pig. Ten blinded laparoscopists rated the videos independently on two scales. Rating time was minimized by allowing raters to fast-forward through the tapes at their discretion. Interrater reliability and the time required to rate a procedure were assessed.Results: Rating time per procedure was a median of 15 min (range, 6-40). The mean interrater reliability for the two scales was 0.74.Conclusions: The use of videotapes of operations enabled multiple raters to assess a performance reliably and shortened assessment times by 80%. This assessment technique shows potential as a means of evaluating the performance of advanced laparoscopic procedures by surgical trainees.

OBJECTIVES:To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice.DESIGN:Double-blind, randomized, controlled trial.SETTING:A tertiary care hospital in Hamilton, Ont.PATIENTS:Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine.INTERVENTION:Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure.MAIN OUTCOME MEASURES:Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narcotic usage.MAIN RESULTS:Mean VAS pain scores (range 0 [no pain] to 5 [severe pain]) at less than 2 hours and at 6 hours after surgery were 2.9 and 2.9, respectively, in the bupivacaine group compared with 4.5 and 4.0, respectively, in the control group (p = 0.001 and 0.025). VAS scores at 10 hours postoperatively and the next morning did not differ between the groups. More patients in the bupivacaine group elected to go home on the day of surgery (p = 0.034). Narcotic usage was not significantly different.CONCLUSION:Instillation of bupivacaine into port sites should be standard practice for elective laparoscopic cholecystectomy.