Duodenum-preserving pancreatic head resection: long-term results

1997 ◽  
Vol 1 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Markus W. Büchler ◽  
Helmut Friess ◽  
Reinhard Bittner ◽  
Rudolf Roscher ◽  
Wolfgang Krautzberger ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Long Term Results ◽  
Pancreatic Head Resection

Duodenum-Preserving Pancreatic Head Resection: Future Standard Operation in Chronic Pancreatitis

Swiss Surgery ◽  
2000 ◽  
Vol 6 (5) ◽  
pp. 254-258 ◽  
Author(s):  
Kondo ◽  
Friess ◽  
Tempia-Caliera ◽  
Büchler
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Extrahepatic Bile Duct ◽  
Pancreatic Head ◽  
Operative Therapy ◽  
Long Term Results ◽  
Pancreatic Head Resection ◽  
Head Region ◽  
Standard Operation

As the incidence of chronic pancreatitis (CP) has risen in most industrialized countries due to increasing alcohol intake, operative therapy has gained importance, and various new operative procedures have been introduced in the past two or three decades. With pancreatic duct drainage operations, pain relief is frequently not satisfactory in long-term follow-up. Pathological studies in combination with modern molecular biology investigations, suggests that the pancreatic head is the "pacemaker" of the disease in most CP patients. Therefore, surgical procedures which aim to remove pancreatic head-related CP complications are needed in most patients. The Whipple operation, which was originally developed to treat malignancies in the pancreatic head region, follows oncological criteria and can therefore be considered surgical overtreatment in the majority of CP patients. As an alternative, the duodenum-preserving pancreatic head resection (DPPHR) was introduced by Hans Beger in 1972 to preserve the stomach, the extrahepatic bile duct and the duodenum. DPPHR is an organ-preserving surgical procedure which provides satisfactory long-term results with regard to mortality, morbidity, pain relief, weight gain and social and professional rehabilitation. Among the operations currently available, DPPHR is the best choice for a new standard operation in patients with pancreatic head-related complications.

scholarly journals Comparative assessment of the short-term and long-term results of traditional and original ways of terminoterminal pancreatojejunostomy at a subtotal resection of a head of a pancreas

2020 ◽  
Vol 25 (1) ◽  
pp. 38-47
Author(s):  
A. R. Propp ◽  
E. N. Degovtsov ◽  
S. A. Nikulina
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Pancreatic Head ◽  
Long Term Results ◽  
Subtotal Resection ◽  
Life Questionnaire ◽  
Short Term ◽  
Quality Of Life Indicators

Aim. Compare the short-term and long-term results of the traditional and original methods of terminoterminal pancreaticojejunostomy with subtotal resection of the pancreatic head.Materials and methods. The results of subtotal resection of the pancreatic head in 20 patients with chronic pancreatitis with pancreatic duct obstruction at the level of the head are analyzed. In 10 cases at the final stage of the operation, the traditional terminoterminal pancreaticojejunostomy was performed, in 10 – in the original way.Results. Biliary tract decompression was performed in 65% of patients. The average duration of operation from original terminoterminal pancreaticojejunostomy operation was 170 min. [165; 180], intraoperative blood loss – 210 ml [200; 240], the average duration of postoperative hospital stay – 16 days [14; 17]; there were no mortality. After 5 years, in all patients who underwent the original terminoterminal pancreaticojejunostomy, the expressiveness of pain according to the developed ten-point scale was <4 points. Frequency for the first time diagnosed diabetes was 50–60%. The need for enzyme drugs was noted in 37.5–40% of cases. The frequency of complications requiring repeated surgical interventions is 12%, persistent disability – 50%. The quality of life indicators for Medical Outcome Study Short Form-36 and European Organisation for Research and Treatment of Cancer quality of life questionnaire – C30 exceeded those of the traditional method of completing the surgery by 3.9–8.4% and 9.3–16.7%.Conclusion. The original way of a single-row terminoterminal pancreaticojejunostomy with subtotal resection of the pancreatic head allows to reduce averages operative time and postoperative hospital stay. The risk of hemorrhagic complications from the resected pancreatic head does not decrease (10%). After 5 years, an insignificant advantage of the original method of terminoterminal pancreaticojejunostomy compared with the traditional one was noted. The incidence of permanent disability was 15% less, the quality of life indicators for the Medical Outcome Study Short Form-36 and European Organisation for Research and Treatment of Cancer quality of life questionnaire – C30 were better.

Patient-reported Long-term Outcomes after Duodenum-preserving Pancreatic Head Resection (Berne Modification) for Chronic Pancreatitis

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S88-S89
Author(s):  
Willem Niesen ◽  
Thomas Hank ◽  
Yoana Angelova ◽  
Ulf Hinz ◽  
Christian Scheele ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Head ◽  
Pancreatic Head Resection ◽  
Long Term Outcomes ◽  
Patient Reported

scholarly journals Immediate and Long-Term Results of Original Methods of Longitudinal Pancreatojejunostomy With The Expansion of the Area of Pancreatojejunal Anastomosis

2020 ◽  
Vol 9 (1) ◽  
pp. 35-45
Author(s):  
A. R. Propp ◽  
E. N. Degovtsov ◽  
S. A. Nikulina
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Pancreatic Head ◽  
Main Group ◽  
Long Term Results ◽  
Hospital Treatment ◽  
Enzyme Preparations

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.

scholarly journals Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis

2016 ◽  
Vol 97 (6) ◽  
pp. 828-832
Author(s):  
R S Shaymardanov ◽  
R F Gubaev ◽  
I I Khamzin ◽  
I I Nuriev
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Biliary Tract ◽  
Pancreatic Head ◽  
Pancreatic Head Resection ◽  
Long Term Follow Up ◽  
The Common

Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.

scholarly journals Non-functioning neuroendocrine tumors of the common hepatic duct: a case report and literature review

2017 ◽  
Vol 4 (3) ◽  
pp. 1101
Author(s):  
Maroun Abou-Jaoude ◽  
Haydar A. Nasser
Keyword(s):  
Neuroendocrine Tumors ◽  
Epigastric Pain ◽  
Hepatic Duct ◽  
Young Patients ◽  
Pancreatic Head ◽  
Long Term Results ◽  
Common Hepatic Duct ◽  
The Common ◽  
Well Differentiated

Extra-hepatic biliary tree neuroendocrine tumors are not common, accounting for about 0.1 % of all carcinoid tumors. Those affecting the common hepatic duct are very rare and their diagnosis is usually made post-operatively. Poorly differentiated tumors or neuroendocrine carcinomas are commonly seen in elderly, whereas well differentiated tumors, tend to occur in young patients, for whom surgery will lead to good long term results. About 100 cases have been reported in the English medical literature, showing good long term results after surgery for well differentiated (Grades 1 and 2) tumors. Herein, we report a case of an 18-year-old female, complaining from a dull epigastric pain related to a nodule compressing the common hepatic duct. After complete investigation, a laparotomy has been performed and showed a nodular tumor located in the common hepatic duct just above the insertion of the cystic duct with close contact with the pancreatic head distally. En bloc cholecystectomy with bile duct resection was performed and followed by a Roux-en-Y hepatico-jejunostomy. The pathology of the nodule came back to be a neuroendocrine tumor grade 2.

LONG-TERM RESULTS OF COMBINED TREATMENT FOR DUCTAL PANCREATIC HEAD ADENOCARCINOMA BY MEANS OF INTRAARTERIAL PERIOPERATIVE CHEMOTHERAPY WITH OXALIPLATIN AND GEMCITABINE

2018 ◽  
Vol 64 (1) ◽  
pp. 116-120
Author(s):  
Aleksandr Pavlovskiy ◽  
Aleksey Polikarpov ◽  
Viktor Moiseenko ◽  
Sergey Popov ◽  
Dmitriy Granov ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Combined Treatment ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Regional Chemotherapy ◽  
Long Term Results ◽  
Ductal Adenocarcinoma ◽  
Perioperative Chemotherapy

Aim. Evaluation of long-term results of perioperative regional chemotherapy with gemcitabine and oxaliplatin in combined treatment of ductal adenocarcinoma of the pancreatic head. Material and methods. The first group consisted of 52 patients who received combined treatment: neoadjuvant chemoembolization (CE) with gemcitabine (400 mg / m2) and oxaliplatin (50 mg / m2) (GemOx), operative treatment, as well as up to 6 courses of chemoinfusion (CI) in the celiac trunk of gemcitabine (1000 mg / m2) and oxaliplatin (75 mg / m2) in the adjuvant regime. In the second group of 51 patients, perioperative regional chemotherapy (neoadjuvant CE and adjuvant CI) with gemcitabine (1000 mg / m 2) (Gem) was performed. 54 patients of the third group performed only operative intervention. Results. No complications associated with medical-diagnostic angiography and catheterization were observed. The median of life expectancy in the group of patients who received only operative treatment was 8.4 ±1.2 months, in the group of perioperative chemotherapy Gem-22.3 ± 1.5, in the group of patients who underwent perioperative regional chemotherapy GemOx-26 ± 1.1 months. Five-year survival rates in the groups were 0%, 10% and 13% and respectively Conclusions. A use of regional chemotherapy with gemcitabine and oxaliplatin can be regarded as a useful and effective step in combined treatment of pancreatic head adenocarcinoma.

Carcinoma of the pancreatic head – Improvement of long-term Results of an oncologic center

2007 ◽  
Vol 44 (07) ◽  
Author(s):  
J Karner ◽  
B Sobhian ◽  
S Thalhammer ◽  
B Horvath-Mechtler ◽  
M Klimpfinger ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Long Term Results
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