Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"A narrative review on the evolution of islet isolation techniques and improving yields during total pancreatectomy and islet autotransplantation.","authors":"Javed Latif, Cristina Pollard, Ashley Dennison, Giuseppe Garcea","doi":"10.14701/ahbps.25-099","DOIUrl":"10.14701/ahbps.25-099","url":null,"abstract":"<p><p>Total pancreatectomy with islet autotransplantation (TPIAT) is a specialized treatment for chronic pancreatitis (CP) patients experiencing intractable pain, aiming to preserve endocrine function and enhance quality of life. This narrative review explores the evolution of islet isolation techniques and their impact on yields and clinical outcomes in TPIAT. PubMed and Google Scholar were searched utilizing the keywords: total pancreatectomy, islet autotransplantation, islet transplantation, TPIAT, islet yields, islet isolation. This review underscores significant advances in islet isolation, from initial collagenase-based methods to the automated Ricordi technique and the enzyme Liberase, which have significantly improved islet yield and viability. Factors such as pancreatic fibrosis, preoperative nutritional status, and ischemia times are critical determinants of outcomes. Higher islet yields (> 5,000 islets/kg) correlate with substantially better insulin independence (20%-40% at 1 year), while pain relief (80%-90%) and quality of life improvements (60%-70%) are consistently observed. Variability in yields due to disease severity and levels of technical expertise continues to pose challenges. TPIAT has evolved into a widely accepted treatment option for CP, with advanced islet isolation techniques contributing to enhanced clinical success. Despite these advancements, variability in islet yields and outcomes highlights the need for standardized protocols and optimized preservation techniques. Future research should aim to address challenges associated with fibrosis and improve long-term graft function, thereby maximizing TPIAT's therapeutic potential.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"240-251"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, treatment and prognosis of simple hepatic cyst: Clinical practice guideline.","authors":"Seoung Yoon Rho, Jeong-Moo Lee, Min-Su Park, Woo-Hyoung Kang, Yoonhyeong Byun, Seung Jae Lee, Aesun Shin, Jeong Hee Yoon, Bohyun Kim, Nam-Joon Yi","doi":"10.14701/ahbps.25-070","DOIUrl":"10.14701/ahbps.25-070","url":null,"abstract":"<p><p>Simple hepatic cysts are now diagnosed in over 8,000 individuals annually in South Korea, largely due to the widespread adoption of medical check-ups and advancements in imaging techniques. However, no appropriate clinical practice guideline has been established to address this condition. While international guidelines have recently been published, differences in clinical and epidemiological contexts have highlighted the need for a tailored guideline to assist domestic clinicians. To address this, the Clinical Practice Guideline Development Committee of Korea Association Hepato-Biliary-Pancreatic Surgery gathered input from surgeons, physicians, radiologists, pathologists, and epidemiology experts to adapt and modify pre-existing international guidelines to better suit domestic realities. This clinical practice guideline aims to provide a clear and appropriate pathway for the management of patients with simple hepatic cysts. It is anticipated that, based on this guideline, clinicians will have a practical framework for diagnosis and treatment. In the near future, it will be necessary to collect high-level evidences to further refine and strengthen recommendations for subsequent guideline updates.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"218-225"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive approach versus open approach in the management of necrotizing acute pancreatitis: A systematic review and meta-analysis.","authors":"Matteo Matteucci, Maria Chiara Ranucci, Salvatore Guarino, Bruno Cirillo, Luca Properzi, Justin Davies, Pietro Ursi, Vito D'Andrea, Roberto Cirocchi","doi":"10.14701/ahbps.25-068","DOIUrl":"10.14701/ahbps.25-068","url":null,"abstract":"<p><p>Acute pancreatitis is one of the most common gastrointestinal diseases, with necrotizing pancreatitis affecting 10% to 15% of patients. Over recent years, the management of pancreatic necrosis has evolved significantly, with a growing shift towards minimally invasive approaches. The aim of this study was to evaluate the effectiveness of minimally invasive approach compared to open surgical approach in managing necrotizing acute pancreatitis. A systematic review and meta-analysis were conducted, including 22 studies. Both fixed-effect and random-effect models were applied to analyze nine outcomes evaluated. Homogeneity among studies was assessed using χ² tests, I² statistics, and <i>p</i>-values. The risk of postoperative mortality, intra-abdominal bleeding, pancreatic and enteric fistulas, perforation, new-onset diabetes, and postoperative sepsis was significantly lower in the minimally invasive approach group than in the open surgical approach group. A minimally invasive approach to necrotizing acute pancreatitis might be associated with a lower risk of complications compared to an open surgical approach. However, most of the included studies were observational studies. Additional randomized trials are needed to further confirm these findings.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"226-239"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic omentopexy as a spacer for carbon-ion radiotherapy in locally advanced pancreatic cancer.","authors":"Sung Hyun Kim, Seo Hee Choi, Moon Jae Chung, Ik Jae Lee, Woong Sub Koom, Chang Moo Kang","doi":"10.14701/ahbps.25-044","DOIUrl":"10.14701/ahbps.25-044","url":null,"abstract":"<p><p>Although half of the patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed at an advanced stage, surgical interventions needed at this stage are currently limited. Carbon-ion radiotherapy (CIRT) has emerged as a promising treatment modality for PDAC owing to its superior physical and radiobiological properties. However, a major challenge in this treatment is the proximity of the pancreas to radiosensitive organs including the stomach and duodenum, which limits dose escalation and increases the risk of severe complications, including ulceration and perforation. Herein, we report our experience with laparoscopic omentopexy as a spacer technique before CIRT in patients with locally advanced PDAC. A 55-year-old female with locally advanced PDAC, secondary to unreconstructible superior mesenteric vein involvement, who had planned to undergo CIRT. After 28 cycles of modified FOLFIRINOX, the tumor size demonstrated slight shrinkage. However, the tumor abutted the posterior wall of the stomach, raising concerns about ensuring a sufficient safety margin while delivering a curative dose of CIRT. Therefore, laparoscopic omentopexy was performed for spacer implantation between the pancreas and stomach. The patient was discharged on the postoperative day 2 without any complications. One month after the omentopexy, the patient completed all 12 fractions of the CIRT with no acute complications, except for grade 1 fatigue. After completing CIRT, the patient underwent regular follow-up evaluations. Laparoscopic omentopexy before CIRT in patients with locally advanced PDAC could enhance therapeutic efficacy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"371-376"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feeding jejunostomy after pancreaticoduodenectomy: Benefit or burden?","authors":"Gilbert Samuel Jebakumar, Siddhesh Tasgaonkar, Jeevanandham Muthiah, Gaurav Chinappa, Santhosh Anand K S, J K A Jameel, Tirupporur Govindaswamy Balachandar, Sudeepta Kumar Swain","doi":"10.14701/ahbps.25-035","DOIUrl":"10.14701/ahbps.25-035","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Pancreaticoduodenectomy (PD) is the standard treatment for resectable tumors of the pancreatic head, ampulla, distal bile duct, and duodenum. Despite advances, delayed gastric emptying (DGE) remains a common complication. Feeding jejunostomy (FJ) is often used during PD, though its necessity and association with increased morbidity, particularly DGE, remain controversial. This study aimed to evaluate early postoperative outcomes in PD patients with or without FJ, focusing on DGE and related complications.</p><p><strong>Methods: </strong>This prospective observational study was conducted from August 2022 to April 2024 and included 56 patients (28 with FJ, 28 without). Primary outcomes were DGE, postoperative pancreatic fistula (POPF), and hospital stay. Secondary outcomes included FJ-related complications, surgical site infections, and time to tolerate solid food. Statistical analysis was performed using SPSS v28.</p><p><strong>Results: </strong>DGE was significantly more frequent in the FJ group (78.6% vs. 39.3%, <i>p</i> = 0.006). Clinically relevant DGE (grades B/C) was also higher with FJ (60.7% vs. 21.4%, <i>p</i> = 0.008). FJ-related complications, including intestinal obstruction requiring reoperation, occurred in 10.7% of patients. Time to tolerate solid food and hospital stay were longer in the FJ group. Multivariate analysis identified FJ use and perioperative blood transfusion as independent risk factors for DGE.</p><p><strong>Conclusions: </strong>Routine FJ placement in PD is associated with increased DGE and tube-related complications. A selective approach to FJ may improve postoperative outcomes. Larger multicenter randomized trials are needed to validate these findings and develop clear guidelines for FJ use in PD.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"317-322"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased use of red blood cell transfusion and associated factors for pancreatic cancer surgery.","authors":"Sunghee Hong, Yun Kyung Jung, Seonju Kim, Junghyun Yoon, Dongho Choi, Boyoung Park","doi":"10.14701/ahbps.25-072","DOIUrl":"10.14701/ahbps.25-072","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>This study investigated perioperative patterns of red blood cell (RBC) transfusion and related determinants in pancreatic cancer surgery using a nationwide Korean database.</p><p><strong>Methods: </strong>We assessed data from the National Health Insurance Service (NHIS) from 2012 to 2020, including newly diagnosed pancreatic cancer patients aged ≥ 20 years who underwent pancreatic surgery within one-year of their diagnosis. Perioperative RBC transfusion was defined as receiving ≥ 1 unit of allogenic RBCs from one week before surgery through hospital discharge.</p><p><strong>Results: </strong>Of the 10,473 patients, 18% underwent perioperative RBC transfusions. The transfusion rate declined from 20.1% in 2012 to 12.7% in 2015, followed by an increase to 19.9% in 2020. In a multivariate analysis, each 10-year increase in age (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.24-1.37), female sex (OR, 1.16; 95% CI, 1.05-1.29), and being in the lowest-income quartile compared to the highest (OR, 1.29; 95% CI, 1.11-1.49) were associated with an increased likelihood of requiring RBC transfusions. A higher Charlson comorbidity index was independently connected to a greater risk as well. Compared with pancreaticoduodenectomy, total pancreatectomy had higher odds (OR, 1.91; 95% CI, 1.56-2.35), whereas distal pancreatectomy had lower odds. Furthermore, general hospitals, compared with tertiary hospitals, were associated with higher transfusion probability (OR, 1.38; 95% CI, 1.22-1.56).</p><p><strong>Conclusions: </strong>Given rising RBC transfusion rates among low-income patients and limited NHIS coverage for new transfusion-sparing methods, Korea should prioritize broader adoption of multidisciplinary blood management over continued reliance on transfusion.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"334-342"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined posterior and left-sided superior mesenteric artery-first approach to the TRIANGLE operation for pancreatic cancer.","authors":"Thanh Khiem Nguyen, Ham Hoi Nguyen, Tuan Hiep Luong, Pisey Chantha, Van Duy Le, Dinh Toi Do, Viet Anh Do, Hong Quang Pham","doi":"10.14701/ahbps.25-064","DOIUrl":"10.14701/ahbps.25-064","url":null,"abstract":"<p><p>We herein present a novel combined posterior and left-sided superior mesenteric artery (SMA) first approach to facilitate the TRIANGLE operation for pancreatoduodenectomy (PD) or total pancreatectomy (TP) in pancreatic cancer. Patients who were diagnosed with resectable pancreatic ductal adenocarcinoma who underwent PD or TP using the combined posterior and left-sided SMA-first approach to the TRIANGLE operation between June 2021 and June 2024 were included in this study. General characteristics, technical details including operative techniques, short-term outcomes, and pathological results were analyzed retrospectively and compared with those from historic cohorts undergoing single SMA-first approach resections. Overall, 126 patients were analyzed (dual-approach PD-TP, n = 33; single-approach PD-TP, n = 93). The dual-approach resection yielded more lymph nodes than the single-approach (36.17 vs 26.53; <i>p</i> < 0.001). Additionally, the rate of tumor-positive resection margins, R1 (direct), was decreased. The duration of the operation was significantly longer, and blood loss was higher with the dual approach. There was no significant difference in postoperative mortality and complications between the two approaches. Utilizing the combined posterior and left-sided first approach to SMA in PD or TP with the TRIANGLE operation proved safe and effective for achieving R0 resection with favorable short-term outcomes in borderline resectable and locally advanced pancreatic cancer.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"353-361"},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex vivo liver resection and autotransplantation following transarterial chemoembolization and stereotactic body radiation therapy for advanced hepatocellular carcinoma.","authors":"Yuzuru Sambommatsu, Vinay Kumaran, Daisuke Imai, Aamir A Khan, Seung Duk Lee, Amit Sharma, Muhammad Saeed, Adrian H Cotterell, David A Bruno","doi":"10.14701/ahbps.25-105","DOIUrl":"https://doi.org/10.14701/ahbps.25-105","url":null,"abstract":"<p><p>Ex vivo liver resection and autotransplantation (ELRAT) is a technically demanding yet increasingly viable option for the treatment of otherwise unresectable tumors with vascular involvement. We describe the case of a 50-year-old female diagnosed with an extensive hepatocellular carcinoma involving the retrohepatic inferior vena cava (IVC) and major hepatic veins, deemed unresectable. After undergoing transarterial chemoembolization and stereotactic body radiation therapy, which resulted in significant tumor necrosis, reduction in lesion size, and a substantial decline in alpha-fetoprotein levels, the patient subsequently underwent ELRAT with IVC reconstruction. Although postoperative complications occurred, such as an incisional hernia and IVC stenosis that necessitated stent insertion, she has remained free of recurrence 24 months following surgery, demonstrating the potential of preoperative therapy to enhance ELRAT outcomes.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total non-division technique of pancreaticoduodenectomy: A strategic integration of superior mesenteric artery-first approach and total mesopancreas excision.","authors":"Vikas Warikoo, Ajinkya Pawar, Varun Muthu, Mohit Sharma, Abhijeet Salunke, Jebin Aaron, Shashank Pandya","doi":"10.14701/ahbps.25-097","DOIUrl":"https://doi.org/10.14701/ahbps.25-097","url":null,"abstract":"<p><p>Pancreaticoduodenectomy remains the only curative intervention for periampullary and pancreatic head cancers, with R0 resection being essential for long-term survival. Nonetheless, the predictive value of preoperative imaging, particularly following neoadjuvant therapy, often remains inadequate. Committing to irreversible surgical steps too early can lead to futile procedures associated with significant morbidity. Here, we introduce the innovative \"Total Non-Division Technique,\" which strategically combines the superior mesenteric artery (SMA)-first approach and total mesopancreas excision (TMpE) to ensure resectability prior to performing any irreversible maneuvers. The procedure initiates with the Cattell Braasch Valdoni manoeuvre, Kocherisation and division of the ligament of Treitz which facilitates a 270-degree duodenal-jejunal derotation, clarifying the SMA and SMV anatomical relationship. Employing a combined posterior and right medial SMA-first approach allows for early vascular control while safeguarding aberrant hepatic arteries. TMpE (type 2 or 3) is achieved en bloc, providing radical clearance within pl-Ph-II between the SMA and celiac axis. Irreversible surgical actions are intentionally deferred until R0 resectability is established, supporting intraoperative decision-making and allowing for procedure abandonment should oncological criteria not be fulfilled. This surgical method enhances rates of R0 resection and reduces morbidity linked to non-curative operations. By avoiding early bile duct transection, contamination risk is minimized, and delayed pancreatic division optimizes margin status and haemostasis. This innovative approach is safe and follows established principles of oncologic surgery, while introducing an intraoperative \"path of escape,\" analogous to Sun Tzu's doctrine of strategic flexibility, ensuring that irreversible commitments are undertaken only upon clear oncological justification.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of Braun enteroenterostomy on delayed gastric emptying after pancreaticoduodenectomy: A prospective study.","authors":"Raghunath Raja Marimuthu, Jyotirmay Jena, Satyaprakash Ray Choudhury, Sumit Subhadarshi Mohanty","doi":"10.14701/ahbps.25-090","DOIUrl":"https://doi.org/10.14701/ahbps.25-090","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Pancreaticoduodenectomy (PD) is a surgical procedure commonly used for periampullary and pancreatic head tumors. Despite surgical advancements, postoperative morbidity remains substantial, with delayed gastric emptying (DGE) being a frequent complication. This prospective study evaluates the impact of Braun enteroenterostomy (BE) on DGE.</p><p><strong>Methods: </strong>Twenty-five consecutive patients undergoing PD were enrolled between May 2023 and August 2024. The retrospective control group consisted of 72 patients who underwent standard PD during the previous four years. The primary outcome measured was the incidence of DGE. Secondary outcomes included the occurrence of postoperative complications and length of stay.</p><p><strong>Results: </strong>The overall incidence of DGE was lower in the Braun group (33.3%) compared to the non-Braun group (46.8%) (<i>p</i> = 0.032). Grade B DGE was less frequent in the Braun group, and no Grade C DGE in either group. Braun group demonstrated a smaller mean pancreatic duct diameter (3.96 mm) than the non-Braun group (5.35 mm) (<i>p</i> = 0.011), yet there was a decrease in the incidence of clinically significant postoperative pancreatic fistula (POPF) (Grade B (8.3% vs 19.4%, <i>p</i> = 0.045) and no Grade C in the Braun group. The mean postoperative hospital stay was significantly shorter in the Braun group (12.5 days) versus the non-Braun group (15.7 days) (<i>p</i> = 0.027). Univariate analysis identified a history of weight loss and elevated CA19-9 associated with DGE, Grade B POPF as an independent risk factor for DGE.</p><p><strong>Conclusions: </strong>Incorporating BE during PD correlates with a lower incidence of DGE, especially for Grades B and C, as well as a reduced rate of Grade B POPF and a shorter postoperative hospital stay.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}