ORCID Profile
0000-0001-7959-5120
Current Organisations
Royal Brisbane and Women's Hospital
,
Changi General Hospital
,
Royal College of Surgeons of Edinburgh
,
National University of Singapore
,
University of Melbourne
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Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1445-2197.2010.05337.X
Abstract: Pancreatic fistulae post distal pancreatectomy still leads to significant morbidity and if not properly managed, may lead to mortality. The identification of risk factors and effective management of patients with pancreatic fistulae is important in the prevention of these complications. There were 75 open consecutive distal pancreatectomies in the Department of Surgery, Changi General Hospital from May 2001 to May 2007. The indications for operation were neuroendocrine tumours (n= 15), adenocarcinoma (n= 20), Intraductal papillary mucinous tumour (IPMT) (n= 20), serous cysts (n= 15) and trauma (n= 5). There were 20 patients (27%) who developed pancreatic fistulae in the whole series. On univariate analysis, the patients with pancreatic fistulae had significantly more pre-morbidities, softer pancreas and use of staplers as a method of closure of the pancreatic remnant. On multivariate analysis, the use of staplers and soft pancreas were significant independent risk factors for the development of pancreatic fistulae in our patient population. All of the patients with pancreatic fistulae were successfully treated non-surgically with no mortality in the whole series. The use of stapler on soft pancreas leads to a higher risk for pancreatic fistulae after distal pancreatectomies. Most pancreatic fistulae can be managed non-surgically with good outcome.
Publisher: Elsevier BV
Date: 08-2023
Publisher: The Korean Association of Hepato-Biliary-Pancreatic Surgery
Date: 04-08-2023
Publisher: Hindawi Limited
Date: 25-05-2013
DOI: 10.1155/2013/536081
Abstract: Recurrent pyogenic cholangitis (RPC) is characterized by repeated infections of the biliary system with the formation of stones and strictures. The management aims are to treat acute cholangitis, clear the biliary ductal debris and calculi, and eliminate predisposing factors of bile stasis. Operative options include hepatectomy and biliary drainage procedures or a combination of both nonoperative options include endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) guided procedures. This current study compares the operative and the nonoperative management outcomes in patients with RPC in 80 consecutive patients. In addition, we aim to evaluate our approach to the management of RPC over the past decade, according to the various degrees of severity and extent of the disease, and identify the patterns of recurrence in this complex clinical condition. Initial failure rate in terms of residual stone of operative compared with nonoperative treatment was 10.2% versus 32.3% ( P = 0.020 ). Long-term failure rate for operative compared with non-operative treatment was 20.4% versus 61.3% ( P = 0.010 ). Based on multivariate logistic regression, the only significant factors associated with failure were bilaterality of disease (OR: 8.101, P = 0.007 ) and nonoperative treatment (OR: 26.843, P = 0.001 ). The median time to failure of the operative group was 48 months as compared to 20 months in the nonoperative group ( P 0.010 ). Thus operative treatment is a durable option in long-term resolution of disease. Hepatectomy is the preferred option to prevent recurrent disease. However, biliary drainage procedures are also an effective treatment option. The utility of nonoperative treatment can achieve a reasonable duration of disease free interval with minimal complications, albeit inferior to operative management.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 04-2008
Publisher: BMJ
Date: 03-01-2014
Publisher: Springer Science and Business Media LLC
Date: 18-11-2021
Publisher: Wiley
Date: 11-05-2019
DOI: 10.1111/ENE.13966
Abstract: Corticobasal syndrome (CBS) is pathologically characterized by tau deposits in neuronal and glial cells and by reactive astrogliosis. In several neurodegenerative disorders, Baseline and 1-year follow-up imaging were acquired using magnetic resonance imaging and positron emission tomography with The 1-year follow-up scan images revealed that Longitudinal increases in
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/ANS.18064
Abstract: There have been few reports on the feasibility and safety of robotic multivisceral surgeries. The da Vinci Xi boasts significant upgrades that improve its applicability in combined resections. We report our early experience of multivisceral, multi‐quadrant resections with the Xi system. Between May 2015 and August 2019, 13 multivisceral resections were performed. Patient demographics, procedural data, and perioperative outcomes were evaluated. The procedures were completed at a median operative time of 290 (range, 210–535) minutes. The median postoperative length of hospital stay was 3.5 (range, 2–7) days. There was one case of readmission for anastomotic leak, but no positioning injuries, external robot arm collisions or issues arising from trocar position. There were no cases of perioperative mortality. Multivisceral resections can be safely accomplished using the Xi. Further studies are necessary to ascertain whether there are benefits of the robotic approach over conventional laparoscopy in these complex cases.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Adrian Chiow.