Chronic pancreatitis surgery: Difference between revisions
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*The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage. | *The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage. | ||
*Laparoscopic LPJ is the minimally invasive procedure with the success rate being directly proportional to the duct size.<ref name="pmid15156382">{{cite journal |vauthors=Tantia O, Jindal MK, Khanna S, Sen B |title=Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases |journal=Surg Endosc |volume=18 |issue=7 |pages=1054–7 |year=2004 |pmid=15156382 |doi=10.1007/s00464-003-9210-x |url=}}</ref><ref name="pmid21584825">{{cite journal |vauthors=Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA |title=Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy |journal=J. Gastrointest. Surg. |volume=15 |issue=7 |pages=1243 |year=2011 |pmid=21584825 |doi=10.1007/s11605-011-1495-9 |url=}}</ref> | *Laparoscopic LPJ is the minimally invasive procedure with the success rate being directly proportional to the duct size.<ref name="pmid15156382">{{cite journal |vauthors=Tantia O, Jindal MK, Khanna S, Sen B |title=Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases |journal=Surg Endosc |volume=18 |issue=7 |pages=1054–7 |year=2004 |pmid=15156382 |doi=10.1007/s00464-003-9210-x |url=}}</ref><ref name="pmid21584825">{{cite journal |vauthors=Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA |title=Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy |journal=J. Gastrointest. Surg. |volume=15 |issue=7 |pages=1243 |year=2011 |pmid=21584825 |doi=10.1007/s11605-011-1495-9 |url=}}</ref> | ||
*Complications such as intraoperative hemorrhage, postoperative hemorrhage and anastomotic leak are less common with this procedure. | *Complications such as intraoperative hemorrhage, postoperative hemorrhage and anastomotic leak are less common with this procedure.<ref name="pmid11371738">{{cite journal |vauthors=Nealon WH, Matin S |title=Analysis of surgical success in preventing recurrent acute exacerbations in chronic pancreatitis |journal=Ann. Surg. |volume=233 |issue=6 |pages=793–800 |year=2001 |pmid=11371738 |pmc=1421322 |doi= |url=}}</ref><ref name="pmid2407040">{{cite journal |vauthors=Greenlee HB, Prinz RA, Aranha GV |title=Long-term results of side-to-side pancreaticojejunostomy |journal=World J Surg |volume=14 |issue=1 |pages=70–6 |year=1990 |pmid=2407040 |doi= |url=}}</ref><ref name="pmid2420294">{{cite journal |vauthors=Sato T, Miyashita E, Yamauchi H, Matsuno S |title=The role of surgical treatment for chronic pancreatitis |journal=Ann. Surg. |volume=203 |issue=3 |pages=266–71 |year=1986 |pmid=2420294 |pmc=1251088 |doi= |url=}}</ref><ref name="pmid3812895">{{cite journal |vauthors=Bradley EL |title=Long-term results of pancreatojejunostomy in patients with chronic pancreatitis |journal=Am. J. Surg. |volume=153 |issue=2 |pages=207–13 |year=1987 |pmid=3812895 |doi= |url=}}</ref><ref name="pmid2580360">{{cite journal |vauthors=Holmberg JT, Isaksson G, Ihse I |title=Long term results of pancreaticojejunostomy in chronic pancreatitis |journal=Surg Gynecol Obstet |volume=160 |issue=4 |pages=339–46 |year=1985 |pmid=2580360 |doi= |url=}}</ref><ref name="pmid7114369">{{cite journal |vauthors=Sarles JC, Nacchiero M, Garani F, Salasc B |title=Surgical treatment of chronic pancreatitis. Report of 134 cases treated by resection or drainage |journal=Am. J. Surg. |volume=144 |issue=3 |pages=317–21 |year=1982 |pmid=7114369 |doi= |url=}}</ref><ref name="pmid8185399">{{cite journal |vauthors=Adams DB, Ford MC, Anderson MC |title=Outcome after lateral pancreaticojejunostomy for chronic pancreatitis |journal=Ann. Surg. |volume=219 |issue=5 |pages=481–7; discussion 487–9 |year=1994 |pmid=8185399 |pmc=1243174 |doi= |url=}}</ref><ref name="pmid17481536">{{cite journal |vauthors=Schnelldorfer T, Lewin DN, Adams DB |title=Operative management of chronic pancreatitis: longterm results in 372 patients |journal=J. Am. Coll. Surg. |volume=204 |issue=5 |pages=1039–45; discussion 1045–7 |year=2007 |pmid=17481536 |doi=10.1016/j.jamcollsurg.2006.12.045 |url=}}</ref> | ||
==== 1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection ==== | ==== 1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection ==== |
Revision as of 16:40, 20 November 2017
Chronic pancreatitis Microchapters |
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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 (LPJ):
- LPJ is the conventional surgical approach for pancreatic drainage.[5][6]
- The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage.
- Laparoscopic LPJ is the minimally invasive procedure with the success rate being directly proportional to the duct size.[7][8]
- Complications such as intraoperative hemorrhage, postoperative hemorrhage and anastomotic leak are less common with this procedure.[6][9][10][11][12][13][14][15]
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.
- ↑ PUESTOW CB, GILLESBY WJ (1958). "Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis". AMA Arch Surg. 76 (6): 898–907. PMID 13532132.
- ↑ 6.0 6.1 Nealon WH, Matin S (2001). "Analysis of surgical success in preventing recurrent acute exacerbations in chronic pancreatitis". Ann. Surg. 233 (6): 793–800. PMC 1421322. PMID 11371738.
- ↑ Tantia O, Jindal MK, Khanna S, Sen B (2004). "Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases". Surg Endosc. 18 (7): 1054–7. doi:10.1007/s00464-003-9210-x. PMID 15156382.
- ↑ Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA (2011). "Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy". J. Gastrointest. Surg. 15 (7): 1243. doi:10.1007/s11605-011-1495-9. PMID 21584825.
- ↑ Greenlee HB, Prinz RA, Aranha GV (1990). "Long-term results of side-to-side pancreaticojejunostomy". World J Surg. 14 (1): 70–6. PMID 2407040.
- ↑ Sato T, Miyashita E, Yamauchi H, Matsuno S (1986). "The role of surgical treatment for chronic pancreatitis". Ann. Surg. 203 (3): 266–71. PMC 1251088. PMID 2420294.
- ↑ Bradley EL (1987). "Long-term results of pancreatojejunostomy in patients with chronic pancreatitis". Am. J. Surg. 153 (2): 207–13. PMID 3812895.
- ↑ Holmberg JT, Isaksson G, Ihse I (1985). "Long term results of pancreaticojejunostomy in chronic pancreatitis". Surg Gynecol Obstet. 160 (4): 339–46. PMID 2580360.
- ↑ Sarles JC, Nacchiero M, Garani F, Salasc B (1982). "Surgical treatment of chronic pancreatitis. Report of 134 cases treated by resection or drainage". Am. J. Surg. 144 (3): 317–21. PMID 7114369.
- ↑ Adams DB, Ford MC, Anderson MC (1994). "Outcome after lateral pancreaticojejunostomy for chronic pancreatitis". Ann. Surg. 219 (5): 481–7, discussion 487–9. PMC 1243174. PMID 8185399.
- ↑ Schnelldorfer T, Lewin DN, Adams DB (2007). "Operative management of chronic pancreatitis: longterm results in 372 patients". J. Am. Coll. Surg. 204 (5): 1039–45, discussion 1045–7. doi:10.1016/j.jamcollsurg.2006.12.045. PMID 17481536.