Aydoğan O, et al. Ann Surg Treat Res. 2025 Feb;108(2):79-85. https://doi.org/10.4174/astr.2025.108.2.79

One of the factors that impair anastomosis healing in patients undergoing hepaticojejunostomy is tension of the anastomosis. There may be tension, especially in cases with a short mesojejunum. In cases where the jejunum cannot be brought higher, positioning the liver a little lower may be a solution. We placed a Bakri balloon between the liver and diaphragm to position the liver to a lower level. Here we present a successful hepaticojejunostomy case in which we placed a Bakri balloon to decrease the anastomosis tension.

Late post-pancreaticoduodenectomy hemorrhage (PPH) is a rare but potentially fatal complication associated with high morbidity and mortality. Early recognition and prompt intervention are critical for improving patient outcomes. This study aimed to evaluate the clinical features, treatment modalities, and outcomes of late-onset PPH cases managed in our institution. Between January 2016 and January 2025, a total of 220 patients underwent pancreaticoduodenectomy (PD) at the Department of General Surgery, XXX University Faculty of Medicine. Patients who developed late arterial hemorrhage, defined by the International Study Group of Pancreatic Surgery (ISGPS) as occurring more than 24 h after the index operation, were included. Demographic data, histopathological diagnoses, timing and source of bleeding, radiological and angiographic findings, treatment modalities, rebleeding events, morbidity, and mortality rates were analyzed. In patients undergoing endovascular treatment (EVT), technical success and complications were recorded. Late PPH occurred in 5.9% (13/220) of patients, with a mean onset of 10.3 days postoperatively. The most frequent bleeding source was the gastroduodenal artery (61.5%), and 61.5% of patients had an anastomotic leak. Sentinel bleeding was present in 76.9% of cases. EVT was performed in eight patients, achieving technical success in 75% after the first attempt and 100% after repeat procedures; rebleeding occurred in 25%. Surgical intervention was performed in five patients, with remnant pancreatectomy required in 60% of cases. Mortality was 60% in the surgical group and 25% in the EVT group. No cases of hepatic ischemia or abscess were observed following hepatic artery embolization. Endovascular therapy appears to be a feasible first-line approach for the management of late PPH and may achieve high technical success. Surgical intervention should be reserved for selected cases in which EVT is unavailable or unsuccessful.

Background and Objectives: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) is a strong prognostic marker in breast cancer and may guide de-escalation of axillary surgery. This study evaluates breast, axillary, and overall pCR rates in initially node-positive patients and examines clinicopathologic predictors of response. Materials and Methods: We retrospectively reviewed 212 women with node-positive invasive breast cancer treated with NAC followed by surgery between February 2019 and July 2025. Breast pCR was defined as ypT0/Tis, axillary pCR as ypN0, and overall pCR as simultaneous clearance of invasive disease in both regions. Associations between pCR and clinical stage, tumor characteristics, and molecular subtypes were analyzed. Results: Breast, axillary, and overall pCR rates were 32%, 61%, and 29%, respectively. Axillary pCR exceeded breast pCR across all subtypes (p