Results of treatment for chronic pancreatitis by the combined Frey and Beger procedure

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

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Modern principles of surgical treatment of chronic pancreatitis

JOURNAL OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE ◽

10.37621/jnamsu-2019-3-306-312 ◽

2019 ◽

pp. 306-312

Author(s):

Volodymyr Kopchak ◽

Mykhailo Nychytailo ◽

Oleksandr Duvalko ◽

Vasyl Khanenko ◽

Volodymyr Trachuk ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Pancreatic Duct ◽

Surgical Techniques ◽

Surgical Interventions ◽

Distal Pancreatic Resection ◽

Initial Surgery ◽

Beger Procedure ◽

Repeated Surgery ◽

Resection Of The Pancreas

We reviewed the charts of 752 patients, who have undergone surgery for various forms of chronic pancreatitis at “Shalimov’s National Institute of Surgery and Transplantation of the NAMS of Ukraine” in the years from 2007 to 2017. The average age of the 591 males (78,6 %) and 161 females (22,4 %) was 43,0 ± 3,2 years. Out of these, 446 (62,4 %) patients with pseudocysts and pancreatic fistula and also with isolated main pancreatic duct lithiasis underwent drainage procedures. The 269 (37.6%) patients were subjected to different types of resection, including the Frey operation, pancreatoenterostomy with artificial pancreatic duct formation, the Berne technique, the Beger procedure, pancreatoduodenectomy, distal-pancreatic resection and other procedures. After pancreatic resections, the patients did not require repeated surgical interventions for chronic pancreatitis. In some cases of chronic pancreatitis, there was an isolated lesion of the pancreas: in such cases (13 patients), we performed distal resection of the pancreas. Among the observed patients here were no fatal cases. Satisfactory results were obtained in 92.6 % of cases at longterm follow-up. Post-operative complications occurred in 27 patients (4.6 %), in 6 (1.03 %) patients there was a need for repeated surgery. Progression of the disease in patients previously operated in our clinic was observed in 32 (5.5 %), and 72 patients, initially operated in other medical institutions. Patients after direct resection of the pancreas did not require repeated surgery for chronic pancreatitis. The main causes of unsatisfactory results of the surgical treatment for chronic pancreatitis have been found to be: false indications for initial surgery, improper primary surgical techniques, insufficient use of drainage procedures, as well as, performing a drainage procedure instead of a resection. Key words: chronic pancreatitis, surgical treatment, resection and drainage procedures. For citation: Usenko OY, Kopchak VM, Nychytailo MY, Duvalko OV, Khanenko VV, Trachuk VI, Khomiak AI. Modern principles of surgical treatment of chronic pancreatitis. Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):306–12

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Laparoscopic Lateral Pancreaticojejunostomy and Laparoscopic Berne Modification of Beger Procedure for the Treatment of Chronic Pancreatitis

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e31829ce803 ◽

2014 ◽

Vol 24 (5) ◽

pp. e178-e182 ◽

Cited By ~ 14

Author(s):

Yazan S. Khaled ◽

Basil J. Ammori

Keyword(s):

Chronic Pancreatitis ◽

Lateral Pancreaticojejunostomy ◽

Beger Procedure ◽

Laparoscopic Lateral Pancreaticojejunostomy

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Frey procedure for chronic pancreatitis: Evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: A meta-analysis

Pancreatology ◽

10.1016/j.pan.2015.05.466 ◽

2015 ◽

Vol 15 (4) ◽

pp. 372-379 ◽

Cited By ~ 23

Author(s):

Yanming Zhou ◽

Bin Shi ◽

Lupeng Wu ◽

Xiurong Wu ◽

Yumin Li

Keyword(s):

Chronic Pancreatitis ◽

Meta Analysis ◽

Long Term Results ◽

Evidence Based ◽

Frey Procedure ◽

Beger Procedure ◽

Short And Long Term

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Results of 100 duodenum-preserving pancreatic head resections for chronic pancreatitis: comparison of FREY- and BEGER procedure

Zeitschrift für Gastroenterologie ◽

10.1055/s-2005-920409 ◽

2005 ◽

Vol 43 (05) ◽

Author(s):

U Adam ◽

F Makowiec ◽

H Riediger ◽

UT Hopt

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Head ◽

Beger Procedure

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Clinical Update: Measuring Shoulder Joint Motion

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1998.sepoct02 ◽

1998 ◽

Vol 3 (5) ◽

pp. 4-5

Author(s):

Christopher R. Brigham

Keyword(s):

External Rotation ◽

Joint Motion ◽

Fourth Edition ◽

Single Plane ◽

Reconstructive Procedures ◽

Results Of Treatment ◽

Shoulder Disorders ◽

Shoulder Motion ◽

Motion Measurements ◽

Upper Extremity Impairment

Abstract Accurate measurement of shoulder motion is critical in assessing impairment following shoulder disorders. To this end, measuring and recording joint motion are important steps in diagnosing, determining the severity and progression of a disorder, assessing the results of treatment, and evaluating impairment. Shoulder movement usually is composite rather than in a single plane, so isolating single movements is challenging. Universal goniometers with long arms are used to measure shoulder motion, and testing must be performed and recorded consistently. Passive motion may be carried out cautiously by the examiner; two measurements of the same patient by the same examiner should lie within 10° of each other. Shoulder extension and flexion are illustrated. Maximal flexion of the shoulder also includes slight external rotation and abduction, and controlling or eliminating these components during evaluation is challenging. Abduction and adduction are illustrated. Deficits in external rotation may occur in patients who have undergone reconstructive procedures with an anterior approach; deficits in internal rotation may result from issues with shoulder instability. The authors recommend recording the shoulder's range of motion measurements according to the Upper Extremity Impairment Evaluation Record in the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition.

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