Chronic pancreatitis surgery: Difference between revisions
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== Surgery for the pain management: == | == Surgery for the pain management: == | ||
*Surgery is usually considered when pain management fails with medical and endoscopic therapies.<ref name="pmid10220505">{{cite journal |vauthors=Ammann RW, Muellhaupt B |title=The natural history of pain in alcoholic chronic pancreatitis |journal=Gastroenterology |volume=116 |issue=5 |pages=1132–40 |year=1999 |pmid=10220505 |doi= |url=}}</ref><ref name="pmid6706066">{{cite journal |vauthors=Ammann RW, Akovbiantz A, Largiader F, Schueler G |title=Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients |journal=Gastroenterology |volume=86 |issue=5 Pt 1 |pages=820–8 |year=1984 |pmid=6706066 |doi= |url=}}</ref><ref name="pmid7926511">{{cite journal |vauthors=Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP |title=The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis |journal=Gastroenterology |volume=107 |issue=5 |pages=1481–7 |year=1994 |pmid=7926511 |doi= |url=}}</ref> | *Surgery is usually considered when pain management fails with medical and endoscopic therapies.<ref name="pmid10220505">{{cite journal |vauthors=Ammann RW, Muellhaupt B |title=The natural history of pain in alcoholic chronic pancreatitis |journal=Gastroenterology |volume=116 |issue=5 |pages=1132–40 |year=1999 |pmid=10220505 |doi= |url=}}</ref><ref name="pmid6706066">{{cite journal |vauthors=Ammann RW, Akovbiantz A, Largiader F, Schueler G |title=Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients |journal=Gastroenterology |volume=86 |issue=5 Pt 1 |pages=820–8 |year=1984 |pmid=6706066 |doi= |url=}}</ref><ref name="pmid7926511">{{cite journal |vauthors=Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP |title=The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis |journal=Gastroenterology |volume=107 |issue=5 |pages=1481–7 |year=1994 |pmid=7926511 |doi= |url=}}</ref> | ||
*The goals of surgery are: | |||
**Effective pain relief | |||
**To reduce morbidity | |||
**To preserve long-term pancreatic function | |||
=== 1. Dilated pancreatic duct: === | === 1. Dilated pancreatic duct: === | ||
* Obstructive pancreatopathy is the underlying pathology in patients with dilated pancreatic duct. | |||
* Patients are usually managed with drainage procedure that may or may not be accompanied with limited resection. | |||
==== 1.1 Lateral pancreaticojejunostomy ==== | ==== 1.1 Lateral pancreaticojejunostomy ==== |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.[1]
Surgery
Chronic pancreatitis causing intractable abdominal pain | |||||||||||||||||||||||||||||||||||||||||
Dilated pancreatic duct (>6-7mm) | Non dilated pancreatic duct (<6-7mm) | ||||||||||||||||||||||||||||||||||||||||
Fibrosis in the head of pancreas Poor drainage | Head-dominant disease | Tail-dominant disease | Diffuse parenchymal involvement | ||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||
Lateral pancreaticojejunostomy (Puestow procedure) | Lateral pancreaticojejunostomy with localized pancreatic head resection (Frey procedure) | Classic pancreaticoduodenectomy OR pylorus-preserving pancreaticoduodenectomy OR Duodenum-preserving pancreatic head resection (Beger procedure) | Distal pancreatectomy | Total pancreatectomy with islet autotransplantation | |||||||||||||||||||||||||||||||||||||
Surgery for the pain management:
- Surgery is usually considered when pain management fails with medical and endoscopic therapies.[2][3][4]
- The goals of surgery are:
- Effective pain relief
- To reduce morbidity
- To preserve long-term pancreatic function
1. Dilated pancreatic duct:
- Obstructive pancreatopathy is the underlying pathology in patients with dilated pancreatic duct.
- Patients are usually managed with drainage procedure that may or may not be accompanied with limited resection.
1.1 Lateral pancreaticojejunostomy
1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection
2. Nondilated pancreatic duct:
2.1 Head-dominant disease
2.1.1 Pancreaticoduodenectomy
2.1.2 Duodenal-preserving pancreatic head resection
2.2 Tail-dominant disease
2.3 Diffuse parenchymal disease
Surgery for the management of complications:
1. Duodenal stenosis
2. Terminal biliary stenosis
3. Pancreatic pseudocysts
4. Gastric varices due to splenic vein occlusion
5. Fibrosing stenosis of the transverse colon
References
- ↑ Society for Surgery of the Alimentary Tract (SSAT) (2004). "Operative treatment for chronic pancreatitis". Retrieved 2007-06-09.
- ↑ Ammann RW, Muellhaupt B (1999). "The natural history of pain in alcoholic chronic pancreatitis". Gastroenterology. 116 (5): 1132–40. PMID 10220505.
- ↑ Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984). "Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients". Gastroenterology. 86 (5 Pt 1): 820–8. PMID 6706066.
- ↑ Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP (1994). "The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis". Gastroenterology. 107 (5): 1481–7. PMID 7926511.