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Pancreatic Neoplasms: HELP
Articles by Richard Maher
Based on 2 articles published since 2010
(Why 2 articles?)
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Between 2010 and 2020, Richard Maher wrote the following 2 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Article Management of recurrent bleeding after pancreatoduodenectomy. 2018

Staerkle, Ralph F / Gundara, Justin S / Hugh, Thomas J / Maher, Richard / Steinfort, Brendan / Samra, Jaswinder S. ·Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia. · Department of Radiology, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia. ·ANZ J Surg · Pubmed #28480620.

ABSTRACT: BACKGROUND: Re-bleeding after management of a first haemorrhage following pancreatic surgery is an ever-present danger and often presents diagnostic and management dilemmas. METHODS: All cases of post-pancreatectomy haemorrhage (PPH) following pancreatoduodenectomy were identified from a tertiary referral, clinical database (April 2004-April 2013). Only those suffering a second re-bleeding episode were included in the final case notes review. RESULTS: A total of 301 patients underwent pancreatoduodenectomy during the study period (most common indication: pancreatic adenocarcinoma; 49.5%). Twenty-two (7.3%) patients suffered a PPH (five early). Of these cases, three suffered a re-bleeding event (one mortality). Endoscopy, interventional radiology and surgery were employed in each case. CONCLUSION: PPH presents major clinical challenges and is associated with significant morbidity and mortality. Early detection of the site and type of bleeding are critical and multimodal therapy is usually required. Interventional radiology techniques are making a major contribution to overall management.

2 Article Endovascular stenting of mesenterico-portal vein stenosis to reduce blood flow through venous collaterals prior to pancreatoduodenectomy. 2015

Chua, Terence C / Wang, Frank / Maher, Richard / Gananadha, Sivakumar / Mittal, Anubhav / Samra, Jaswinder S. ·Department of Gastrointestinal Surgery, Discipline of Surgery, University of Sydney, Sydney, NSW, Australia, terence.c.chua@gmail.com. ·Langenbecks Arch Surg · Pubmed #25998372.

ABSTRACT: BACKGROUND: When the mesenterico-portal vein is stenosed due to tumor related compression, venous collaterals develop and flow occurs antegrade towards the portal vein through the collateral tributaries. Undertaking pancreatoduodenectomy for pancreatic cancer in this setting may result in significant blood loss during the process of ligation of these tributaries. DESCRIPTION OF TECHNIQUE: We describe the technique of endovascular stenting of the mesenterico-portal vein to reduce flow within these collateral tributaries and hence blood loss, to facilitate extended pancreatoduodenectomy and vein resection. CONCLUSION: Percutaneous transhepatic placement of endovascular stent into a stenotic mesentero-portal vein facilitates pancreatoduodenectomy by reducing operative time, which would otherwise be required in dealing with the extensive venous collaterals and hence also reducing blood loss.