Early pain relief surgery improves long-term chronic pancreatitis outcomes

2012 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief

The Liverpool duodenum-and spleen-preserving near-total pancreatectomy can provide long-term pain relief in patients with end-stage chronic pancreatitis

2019 ◽  
Vol 404 (7) ◽  
pp. 831-840 ◽  
Author(s):  
A. R. G. Sheel ◽  
R. D. Baron ◽  
L. D. Dickerson ◽  
P. Ghaneh ◽  
F. Campbell ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Total Pancreatectomy ◽  
Spleen Preserving ◽  
End Stage

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.

Long-term Outcomes Favor Duodenum-preserving Pancreatic Head Resection over Pylorus-preserving Pancreaticoduodenectomy for Chronic Pancreatitis: A Meta-analysis and Systematic Review

2015 ◽  
Vol 81 (9) ◽  
pp. 909-914 ◽  
Author(s):  
Prashant B. Sukharamwala ◽  
Krishen D. Patel ◽  
Anthony F. Teta ◽  
Shailraj Parikh ◽  
Sharona B. Ross ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Head ◽  
Long Term Outcomes ◽  
Perioperative Morbidity ◽  
Endocrine Insufficiency ◽  
Significant Difference

Pylorus-preserving pancreaticoduodenectomy (PPPD) and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. This meta-analysis was undertaken to compare the long-term outcomes of DPPHR versus PPPD in patients with chronic pancreatitis. A systematic literature search was conducted using Embase, MEDLINE, Cochrane, and PubMed databases on all studies published between January 1991 and January 2013 reporting intermediate and long-term outcomes after DPPHR and PPPD for chronic pancreatitis. Long-term outcomes of interest were complete pain relief, quality of life, professional rehabilitation, exocrine insufficiency, and endocrine insufficiency. Other outcomes of interest included perioperative morbidity and length of stay (LOS). Ten studies were included comprising of 569 patients. There was no significant difference in complete pain relief ( P = 0.24), endocrine insufficiency ( P = 0.15), and perioperative morbidity ( P = 0.13) between DPPHR and PPPD. However, quality of life ( P < 0.00001), professional rehabilitation ( P = 0.004), exocrine insufficiency ( P = 0.005), and LOS ( P = 0.00001) were significantly better for patients undergoing DPPHR compared with PPPD. In conclusion, there is no significant difference in endocrine insufficiency, postoperative pain relief, and perioperative morbidity for patients undergoing DPPHR versus PPPD. Improved intermediate and long-term outcomes including LOS, quality of life, professional rehabilitation, and preservation of exocrine function make DPPHR a more favorable approach than PPPD for patients with chronic pancreatitis.

Surgical outcomes and long-term pain relief after Frey procedure for chronic pancreatitis

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S150
Author(s):  
Toshiki Matsui ◽  
Akihiro Tanemura ◽  
Yusuke Iizawa ◽  
Hiroyuki Kato ◽  
Yasuhiro Murata ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Surgical Outcomes ◽  
Frey Procedure

Long-Term Pain Relief With Optimized Medical Therapy Including Antioxidants in Patients With Chronic Pancreatitis

2011 ◽  
Vol 140 (5) ◽  
pp. S-547 ◽  
Author(s):  
S. Shalimar ◽  
Shallu Midha ◽  
Payal Bhardwaj ◽  
Pramod K. Garg
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Medical Therapy

Patient with Chronic Abdominal Pain from Pancreatitis

2016 ◽  
Author(s):  
Jianguo Cheng
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Imaging Techniques ◽  
Physical Symptoms ◽  
Chronic Abdominal Pain ◽  
Celiac Plexus ◽  
Comprehensive Treatment ◽  
Gastrointestinal Complications

Early diagnosis of chronic pancreatitis is possible by combining clinical information with pancreatic function testing, endoscopic ultrasonography, histology, and traditional imaging techniques such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Such an approach helps improve the sensitivity and specificity of these complementary modalities. Pain management of chronic pancreatitis involves multidisciplinary and multimodal approaches. Behavioral modifications such as alcohol cessation, nutritional optimization, and cognitive-behavioral therapy play a significant role for better long-term outcomes. Pharmacologic management is directed at relieving both psychological and physical symptoms, and combination pharmacotherapies are often needed to address pancreatic deficiency, abdominal pain, and psychological disorders. Interventional approaches to celiac plexus and splanchnic nerve blocks and denervation (radiofrequency ablation, endoscopic or surgical denervation) may provide significant and prolonged pain relief. Neuromodulation in the form of spinal cord stimulation is a viable option for long-term pain relief. Managing complications of chronic pancreatitis, such as gastrointestinal complications (peptic ulcer, bile duct stenosis), pseudocysts, malnutrition, depression, diabetes, and painful diabetic neuropathy, is an integral part of comprehensive treatment and requires close collaboration between members of a multidisciplinary team.   This review contains 1 figures, 2 tables and 64 references Key words: behavioral modifications, celiac plexus, chronic abdominal pain, chronic pancreatitis, interventional therapy, pharmacologic modulation, splanchnic nerves, surgical intervention

Total Pancreatectomy for the Treatment of Chronic Pancreatitis: Indications, Outcomes, and Recommendations

2006 ◽  
Vol 72 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Stephen W. Behrman ◽  
Matthew Mulloy
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Total Pancreatectomy ◽  
Long Term Results ◽  
Gastrojejunal Anastomosis ◽  
Hereditary Pancreatitis ◽  
Anastomotic Complications ◽  
The Mean

Total pancreatectomy (TP) for chronic pancreatitis (CP) has not gained widespread acceptance because of concerns regarding technical complexity, diabetic complications, and uncertainty with respect to long-term pain relief. Records of patients having TP from 1997 to 2005 were reviewed. Patient presentation, etiology of disease, and the indication for TP were examined. Operative results were analyzed. Long-term results were critically assessed, including narcotic usage and the need for re-admission. Postoperative quality of life (QOL) was assessed by the SF-36 health survey. During the study period, 7 patients with CP had TP, and 28 had other operations. The etiology of CP was alcohol in four and hereditary pancreatitis in three. The indication for surgery was pain and weight loss. Preoperatively, all patients used narcotics chronically and two had insulin-dependent diabetes. Four had TP after failed previous surgical procedures. Endoscopic retrograde cholangiopancreatography and computed tomography demonstrated small ducts and atrophic calcified glands. The mean length of the operation was 468 minutes, and only two patients required transfusion. There were no biliary anastomotic complications. The mean length of stay was 14 days. Major morbidity was limited to a single patient with a leak from the gastrojejunal anastomosis. Thirty-day mortality was zero, with one late death unrelated to the surgical procedure or diabetes. The mean length of follow-up was 46 months. All patients remained alcohol and narcotic free. No patient was readmitted with a diabetic complication. When compared with the general population, QOL scores were diminished but reasonable. We conclude that TP is indicated in hereditary pancreatitis and in those with an atrophic, calcified pancreas with small duct disease; that TP is technically arduous but can be completed with very low morbidity and mortality; and that on long-term follow-up, pain relief and abstinence from alcohol and narcotics was excellent with an acceptable QOL.

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