2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
they had further training in endoscopy prior to starting practice
as opposed to 46% (p< 0.05) of non-rural surgeons.
Rural surgeons perform flexible endoscopy at a much higher
rate than their non-rural counterparts. The majority of rural
surgeons feel they would have benefited from additional flexible
endoscopy training prior to entering practice.
P184–Hepatobiliary/Pancreatic
Surgery
TO DETERMINE THE VALUE OF DIAGNOSTIC LAPAROSCOPY
IN PATIENTS WITH POTENTIALLY RESECTABLE ADENOCARCI-
NOMA OF PANCREAS, Syed I Ahmed MD, Dmitry Oleynikov
MD,Brian K Zebrowski MD,Arron Sasson MD, University of
Nebraska medical center, Omaha
Introduction:
Minimally invasive surgical techniques especially staging
laparoscopy can determine resectability of pancreatic adenocarcinoma.
This may spare unnecessary laparotomy and its
associated morbidity to non resectable patients with advanced
disease. Therefore the aim of this study is to identify patients
at our institution with unresectable pancreatic adenocarcinoma
prior to non therapeutic laparotomy.
Method:
The records of patients undergoing pancreatic surgery were
reviewed from 2001 to 2004 from a prospectively maintained
data base. Inclusion criteria consisted of patients with adenocarcinoma
of pancreas whereas non pancreatic peri-ampullary
carcinomas, cystic neoplasm, and endocrine tumors were
excluded. All patients were staged with a high resolution computed
tomography (CT) scan prior to surgical intervention.
Results:
Fifty four patients meeting the above criteria were included in
the study. These patients were identified and deemed
resectable by routine preoperative staging. Thirty five patients
underwent exploratory laparoscopy (Group I). Nineteen proceeded
directly to laparotomy (Group II). In Group I, 10
patients (28.6%) had obvious detectable metastatic disease at
laparoscopy and were deemed unresectable. An additional 6
patients were deemed locally unresectable radiographically
and had staging laparoscopy only. The remaining 19 patients
(Group I) proceeded to resection with curative intent but 2
were found to have metastatic disease at laparotomy (false
negative rate of 10.5%). 2 had locally advanced but non
metastatic disease and were deemed unresectable. The combination
of these 2 false negative patients and the 10 patients
identified as having metastatic disease (true positive) represent
34.2% of patient that were not resectable and would have
ultimately benefited from laparoscopic staging. The reason for
not performing laparoscopy in group II included need for biliary
decompression, and extensive abdominal adhesions.
Conclusion:
In this series, laparoscopy altered the management in 28.6% of
the patient undergoing resection for pancreatic malignancy.
The morbidity and hospital stay was reduced significantly by
not having to proceed to laparotomy in non resectable cases.
Potentially up to 10.5% patients could have avoided laparotomy
if all false negatives were detected. This false negative
could be decreased by adding intraoperative laparoscopic
ultrasound in future.
P185–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLENIC
PRESERVATION FOR SEROUS CYSTADENOMA OF THE PAN-
CREAS: A CASE REPORT AND LITERATURE REVIEW,
Kanayochukwu J Aluka MD, Cynthia Long MD,Terrence M
Fullum MD, Providence Hospital
Introduction: A minimally invasive approach can be beneficial
in spleen preserving distal pancreatectomy. We present a 71
year old female in which laparoscopy was used for resection
of an incidental 4cm x 3cm x 2cm serous cystadenoma of the
pancreas.
Method: A 71 year old female who presented to her internist
with HTN and persistent hypokalemia had an MRI to rule out
an adrenal mass. The MRI revealed a lesion of the distal pancreas
and normal adrenal glands. She was referred to the
174 http://www.sages.org/
General Surgery Service for resection of the distal pancreatic
lesion. A laparoscopic spleen preserving distal pancreatectomy
was performed using the EndoGIA? linear cutter stapler with
PeriStrips?.
Results: The pathology report revealed a completely excised
cystic lesion with a diagnosis of serous cystadenoma with
focal fibrosis and atrophic acini. Postoperatively the advantages
of the laparoscopic approach were exemplified with the
patient?s early return of bowel function, minimal narcotic
requirements and early resumption of normal activities.
Conclusion: This case illustrates the advantages of minimally
invasive surgery in the performance of a spleen preserving
distal pancreatectomy.
P186–Hepatobiliary/Pancreatic
Surgery
THE EFFECTS OF PRE-OPERATIVE ROFECOXIB, METOCLO-
PRAMIDE HYDROCHLORIDE DEXAMETHASONE, AND
ONDANSETRON ON POST OPERATIVE PAIN AND NAUSEA IN
PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTO-
MY, Marc C Antonetti MD, Phiet Bui, Orlando Kirton
MD,Richard Lilly MD, University of Connecticut
Improvements in the safety and efficiency of laparoscopic
cholecystectomy (LC) have transformed this operation into an
outpatient procedure. Postoperative pain and nausea are
deterrents to eventual same day discharge. No trial to date has
evaluated the combined effect of pre-operative Rofecoxib,
Metoclopramide, Dexamethasone, and Ondansetron on postoperative
pain and nausea in patients undergoing LC.
A prospective randomized double-blinded placebo controlled
trial was conducted on patients undergoing elective LC at a
single tertiary referral center from January 2002 until June
2004. The patients in the intervention group received
Rofecoxib 25 mg PO during the admission process. All
patients were given a standard anesthetic regimen.
Additionally the study group received Metoclopramide 10 mg
IV and Dexamethasone 4 mg IV after induction; and
Ondansetron 4 mg just prior to closure. Local anesthetic was
administered to all wounds at the conclusion of the procedure.
A 0-10 box scale was used to rate pain and nausea pre-operatively,
on arrival at PACU, 0.5, 1.5, 3, 6 and 9 hours after
arrival, at discharge, and at 24 hour follow-up.
Of the 249 patients consented, 44 were excluded for a final
study sample of 205. There were 97 patients in the control
group, and 108 received intervention. 16% of the patients were
male; 84% were female. The intervention and control groups
were compatible on most demographic and health characteristics.
The intervention group had a significantly smaller proportion
of men than control group (10% vs. 23%; p