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Pancreaticoduodenectomy for the treatment of groove pancreatitis. Dig Dis Sci 2012; 57:1954-8. [PMID: 22610883 DOI: 10.1007/s10620-012-2214-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 04/25/2012] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Groove pancreatitis is a segmental form of chronic pancreatitis that can be treated with pancreaticoduodenectomy (PD), although outcome studies for this approach are lacking. We performed an assessment of pain symptoms, need for opioids, and weight gain following PD for symptomatic groove pancreatitis. METHODS The study was a retrospective case series describing all patients with groove pancreatitis who underwent PD at our medical center. The primary outcome was the change in pain level and opioid use following PD. RESULTS Five patients underwent PD for treatment of groove pancreatitis. Patients' perception of pain, using a 10-point visual analog scale, improved after surgery from 5.0 to 0.2. Opioid analgesics, as measured by oral morphine equivalents, dropped from 77.6 to 0 mg daily, with all five patients being completely free of opioids post-operatively. Weight loss ceased in all five patients, with an overall mean weight gain of 15.4 pounds post-operatively. CONCLUSIONS PD reduces pain and opioid analgesic use in groove pancreatitis. This intervention should be considered for patients with this condition.
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Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, Frulloni L, Crippa S, Zamboni G, Pederzoli P. "Paraduodenal" pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2010; 33:2664-9. [PMID: 19809849 DOI: 10.1007/s00268-009-0238-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cystic dystrophy of heterotopic pancreas, groove pancreatitis, pancreatic hamartoma of the duodenum, paraduodenal wall cyst, and myoadenomatosis are all terms grouped together, from a pathological viewpoint, as definitions of paraduodenal pancreatitis (PP). The objective of the present study was to investigate the clinical characteristics, therapeutic strategies, and results in 58 patients undergoing pancreatic resection for PP. METHODS From January 1990 to December 2006 data were prospectively collected on 58 patients who were diagnosed with PP who then underwent pancreaticoduodenectomy. RESULTS In this patient cohort the median age was 44.7 years; only 4 patients were women, and only 3 had non-drinker and/or non smoker habits. The overall morbidity was 18.9%, and the median hospitalization was 11 days. There were no postoperative deaths. In a median follow-up of 96.3 months, all patients noted a decrease in the pain associated with PP; 35 patients (76%) had complete disappearance of pain, whereas occasional relapsing pain occurred in the remaining 11 (24%). CONCLUSIONS Patients with PP have clinical characteristics similar to those of chronic pancreatitis. The diagnostic imaging modalities of choice are ultrasonographic endoscopy and magnetic resonance cholangiopancreaticography. Based on our surgical experience, pancreaticoduodenectomy seems to be a reasonable choice of treatment in patients with PP.
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Affiliation(s)
- L Casetti
- Dipartimento di Scienze Chirurgiche, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 37134 Verona, Italy
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Büchler MW, Martignoni ME, Friess H, Malfertheiner P. A proposal for a new clinical classification of chronic pancreatitis. BMC Gastroenterol 2009; 9:93. [PMID: 20003450 PMCID: PMC2804657 DOI: 10.1186/1471-230x-9-93] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 12/14/2009] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The clinical course of chronic pancreatitis is still unpredictable, which relates to the lack of the availability of a clinical classification. Therefore, patient populations cannot be compared, the course and the outcome of the disease remain undetermined in the individual patient, and treatment is not standardized. AIM To establish a clinical classification for chronic pancreatitis which is user friendly, transparent, relevant, prognosis- as well as treatment-related and offers a frame for future disease evaluation. METHODS Diagnostic requirements will include one clinical criterion, in combination with well defined imaging or functional abnormalities. RESULTS A classification system consisting of three stages (A, B and C) is presented, which fulfils the above-mentioned criteria. Clinical criteria are: pain, recurrent attacks of pancreatitis, complications of chronic pancreatitis (e.g. bile duct stenosis), steatorrhea, and diabetes mellitus. Imaging criteria consist of ductal or parenchymal changes observed by ultrasonography, ERCP, CT, MRI, and/or endosonography. CONCLUSION A new classification of chronic pancreatitis, based on combination of clinical signs, morphology and function, is presented. It is easy to handle and an instrument to study and to compare the natural course, the prognosis and treatment of patients with chronic pancreatitis.
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Affiliation(s)
- Markus W Büchler
- Department of General Surgery, University of Heidelberg, Germany
| | | | - Helmut Friess
- Department of Surgery, Technical University Munich, Germany
| | - Peter Malfertheiner
- Department of Gastroenterology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
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Frulloni L, Gabbrielli A, Pezzilli R, Zerbi A, Cavestro GM, Marotta F, Falconi M, Gaia E, Uomo G, Maringhini A, Mutignani M, Maisonneuve P, Di Carlo V, Cavallini G. Chronic pancreatitis: report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis 2009; 41:311-7. [PMID: 19097829 DOI: 10.1016/j.dld.2008.07.316] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 07/22/2008] [Accepted: 07/25/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND No data on chronic pancreatitis in Italy are available yet. AIM To evaluate demographic, clinical, diagnostic and therapeutic aspects in patients suffering from chronic pancreatitis. PATIENTS AND METHODS Eligible patients were prospectively enrolled from 2000 to 2005. Information concerning demographic data, lifestyle risk factors, family and clinical history, associated factors (alcohol, autoimmunity, cystic dystrophy of the duodenal wall, obstruction, genetic mutations) concomitant diseases, diagnostic findings, and pharmacological, endoscopic and surgical therapy were gathered. RESULTS 893 patients (74% males, mean age 53.7+/-15.2 years) were evaluated. 519/859 patients (60%) were drinkers and 555/840 (66%) were smokers. A strong positive correlation between drinking and cigarette consumption (R=0.53; p<0.0001) was found. Heavy alcohol consumption (>80g of alcohol/day for more than 5 years) was considered the most important risk factor in 300 patients (34%), obstruction in 238 (27%), alcohol and obstruction in 82 (9%), autoimmunity in 34 (4%), cystic dystrophy of the duodenal wall/groove pancreatitis in 55 (6%), gene mutations in 36 (4%), and none (idiopathic) in 148 (17%). Bile stones were diagnosed in 287 patients (33%) and cholecystectomy was performed in 329 patients (38%). Pancreatic calcifications were diagnosed in 547/879 patients (62%). Pancreatic surgery was performed in 273 patients (31%). Endoscopic sphincterotomy was performed in 371 patients (42%). Exocrine and endocrine insufficiency were found, respectively, in 373/834 (45%) and 275/885 patients (31%). CONCLUSIONS An unexpected low frequency of alcohol abuse and new emerging associated risk factors for chronic pancreatitis were observed in Italy.
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Affiliation(s)
- L Frulloni
- Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy.
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Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761-8. [PMID: 17981197 DOI: 10.1016/j.surg.2007.05.005] [Citation(s) in RCA: 2043] [Impact Index Per Article: 120.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Revised: 03/14/2007] [Accepted: 05/11/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. METHODS After a literature review on DGE after pancreatic resection, the International Study Group of Pancreatic Surgery (ISGPS) developed an objective and generally applicable definition with grades of DGE based primarily on severity and clinical impact. RESULTS DGE represents the inability to return to a standard diet by the end of the first postoperative week and includes prolonged nasogastric intubation of the patient. Three different grades (A, B, and C) were defined based on the impact on the clinical course and on postoperative management. CONCLUSION The proposed definition, which includes a clinical grading of DGE, should allow objective and accurate comparison of the results of future clinical trials and will facilitate the objective evaluation of novel interventions and surgical modalities in the field of pancreatic surgery.
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Affiliation(s)
- Moritz N Wente
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany
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Nair RR, Lowy AM, McIntyre B, Sussman JJ, Matthews JB, Ahmad SA. Fistulojejunostomy for the management of refractory pancreatic fistula. Surgery 2007; 142:636-42; discussion 642.e1. [PMID: 17950358 DOI: 10.1016/j.surg.2007.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 07/26/2007] [Accepted: 08/18/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic fistula (PF) formation is a known complication of pancreatic surgery, pancreatitis, and pancreatic injury. When medical or endoscopic interventions fail to resolve PF, operation remains the only viable treatment option. Unfortunately, operation for the correction of PF is often difficult and associated with significant morbidity. METHODS Herein, we report on our experience with a previously described technique for the management of PF that is performed easily and is associated with reduced morbidity. During the period of 2003-2006, 8 patients (males = 6, female = 2) with PF were treated with prolonged percutaneous drainage. Once a mature scar tract formed around the percutaneous drain, patients underwent a fistulojejunostomy. RESULTS The age of these patients ranged from 43 to 61 years. Of the 8 patients, 5 had fistulas secondary to necrotizing pancreatitis. The remaining 3 patients had fistulas resulting from previous pancreatic surgery. The average interval between drain placement and fistulojejunostomy was 6 months (range, 4-7 months). The average duration of operation was 2.5 h (range, 1-4.5 h). The average blood loss was 280 mL (range, 50-600 mL). Average duration of stay was 9 days (average, 4-14 days). At a mean follow-up of 17 months (range, 2-58 months), 6 of 8 patients had resolution of their pancreatic fistulas, could resume regular diet, and were free of narcotic use. One patient developed a recurrent pseudocyst and required a distal pancreatectomy, and the final patient was lost to follow-up. CONCLUSIONS Fistulojejunostomy is an effective therapy for the definitive treatment of pancreatic fistulas.
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Affiliation(s)
- Rajalakshmi R Nair
- Department of Surgery, The University of Cincinnati Medical Center, Cincinnati, Ohio 45247, USA
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Fazel A. Postoperative Pancreatic Leaks and Fistulae: The Role of the Endoscopist. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2006. [DOI: 10.1016/j.tgie.2006.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Falconi M, Bassi C, Casetti L, Mantovani W, Mascetta G, Sartori N, Frulloni L, Pederzoli P. Long-term results of Frey's procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 2006; 10:504-10. [PMID: 16627215 DOI: 10.1016/j.gassur.2005.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 09/07/2005] [Accepted: 09/12/2005] [Indexed: 02/07/2023]
Abstract
Only limited prospective data are available regarding the long-term outcome of local resection of the pancreatic head in combination with longitudinal pancreaticojejunostomy in patients with chronic pancreatitis. From 1997 to 2001, 40 patients affected by chronic pancreatitis were subjected to the Frey's procedure. Preoperative selection criteria included confirmed diagnosis of chronic pancreatitis, dilation of Wirsung's duct to a diameter greater than 6 mm, and the absence of obstructive chronic pancreatitis secondary to fibrotic stenosis at the pancreatic body or tail. Preoperative pain was present in 38 cases (95%), and follow-up was performed in all patients at least once yearly up to 2003 (median 60 months, inter percentile range 20.1-79.6). Postoperative morbidity occurred in three cases (7.5%). The percentage of pain-free patients was 94.7%, 93.7%, 87.5%, and 90% at 1, 2, 3, and 4/5 years after surgical operation, respectively. After surgery, three patients developed diabetes. Both the body mass index and quality of life showed statistically significant improvements at all follow-up intervals. Whenever surgery is indicated, the short-term and long-term outcomes confirm that Frey's procedure is an appropriate means of management for patients with chronic pancreatitis in the absence of doubts of neoplasia and/or distal ductal obstruction.
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Affiliation(s)
- Massimo Falconi
- Department of Surgical, University of Verona, Verona, Italy.
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Wani NA, Parray FQ, Wani MA. Is any surgical procedure ideal for chronic pancreatitis? Int J Surg 2006; 5:45-56. [PMID: 17386915 DOI: 10.1016/j.ijsu.2006.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 01/17/2006] [Accepted: 01/18/2006] [Indexed: 12/16/2022]
Abstract
Chronic pancreatitis continues to be a major therapeutic challenge for all pancreatic surgeons. This article is written with a purpose to review various surgical procedures developed from time to time for the relief of pain in these patients. Since no single procedure can be labeled as "ideal" because of the problems of the inability to address the whole pathology at the initial procedure, failure or recurrence of the pain; most of the pancreatic and practicing surgeons may benefit from knowledge of the various procedures being performed, even though the personal experience of the surgeon most of the time ultimately dictates the final choice of the procedure for the patient.
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Affiliation(s)
- Nazir A Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir 190011, India
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Alexakis N, Ghaneh P, Connor S, Raraty M, Sutton R, Neoptolemos JP. Duodenum- and spleen-preserving total pancreatectomy for end-stage chronic pancreatitis. Br J Surg 2003; 90:1401-8. [PMID: 14598422 DOI: 10.1002/bjs.4324] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Abstract
Background
Total pancreatectomy may be warranted in patients with advanced chronic pancreatitis in whom partial resection has failed and in those with end-stage pancreatic function. A new operation, duodenum- and spleen-preserving total pancreatectomy, is described.
Methods
Nineteen consecutive patients with chronic pancreatitis who had duodenum- and spleen-preserving total pancreatectomy were studied.
Results
There were 15 men and four women with a median age of 40 (range 29–64) years. The aetiology was alcohol misuse in nine, hereditary pancreatitis in five and idiopathic in five patients. All patients had chronic intractable abdominal pain. Six had undergone pancreatic surgery previously and one had had multiple coeliac plexus blocks. There were ten postoperative complications in five patients, and one hospital death. The median hospital stay was 25 (range 10–84) days. There was a reduction in pain (P < 0·001) and analgesic use (P < 0·001) after surgery, and weight gain was noted at 12 and 24 months (P < 0·001). Nine patients required readmission to hospital, four because of surgical complications: adhesional obstruction in one, biliary stricture in two and duodenal obstruction in one. In the other five patients (four of whom had long-standing pre-existing diabetes mellitus) readmission was for better control of pain (three patients), diabetes mellitus (two), and diabetes-associated diarrhoea (two) or gastropathy (one).
Conclusion
Duodenum- and spleen-preserving total pancreatectomy has a role in selected patients with medically intractable pain from chronic pancreatitis.
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Affiliation(s)
- N Alexakis
- Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, Daulby Street, Liverpool L69 3GA, UK
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Yoon DY, Reber HA. Pancreatic surgery. Curr Opin Gastroenterol 2001; 17:441-5. [PMID: 17031198 DOI: 10.1097/00001574-200109000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Recent advances have been made in both laparoscopic and endoscopic techniques for diagnosing and treating pancreatic neoplasms. These advances are reviewed. In addition to the traditional methods of pancreatic resection (eg, standard Whipple and pylorus-preserving Whipple), several other techniques have been described and are discussed (eg, median pancreatectomy and extended pancreatectomy). The morbidity and mortality rates of pancreatic operations have diminished, but significant complications still occur (eg, delayed gastric emptying, pancreatic fistula, and biliary strictures). These are discussed. In managing acute and chronic pancreatitis, less invasive and more conservative approaches are being advocated.
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Affiliation(s)
- D Y Yoon
- Division of General Surgery, UCLA School of Medicine, Los Angeles, California 90095-6904, USA
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