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

Aim. To study the early postoperative outcomes of duodenum-preserving total pancreatic head resections in benign, premalignant tumors of the pancreatic head and chronic pancreatitis complicated by duodenal dystrophy in comparison with the results of pylorus-preserving pancreaticoduodenectomy. Materials and methods. From 2006 to 2019, 54 patients underwent duodenum-preserving total pancreatic head resection for chronic pancreatitis complicated by duodenal dystrophy, benign or premalignant tumors of the pancreatic head. At the same time, in 25 cases, the operation was performed in an isolated version, in 29 – with a resection of the duodenum. As a comparison group, we used data from 89 patients who underwent pyloruspreserving pancreaticoduodenectomy during the same period. Results. Compared to pancreaticoduodenectomy, duodenum-preserving total pancreatic head resection exhibits significantly longer times for surgery (420 and 310 minutes, respectively). There was no statistically significant difference in the volume of intraoperative blood loss. There are no differences between groups in hospital morbidity (the frequency of pancreatic fistulas, delayed gastric emptying, bile leakage and post-resection bleeding). The frequency of postoperative complications for Clavien-Dindo III and higher did not differ significantly in the groups. There is no hospital mortality after duodenum-preserving total pancreatic head resection; three patients died after pancreatoduodenectomy. Conclusion. Early postoperative outcomes following duodenum-preserving total pancreatic head resection and pylorus-preserving pancreaticoduodenectomy are comparable. However, to develop a full-fledged concept of surgical treatment of pancreatic head benign, premalignant neoplasms and chronic pancreatitis with duodenal dystrophy, it is necessary to analyze the long-term outcomes of treatment.

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Long-term Follow-up After Organ-Preserving Pancreatic Head Resection in Patients with Chronic Pancreatitis

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-007-0324-7 ◽

2007 ◽

Vol 12 (2) ◽

pp. 308-312 ◽

Cited By ~ 16

Author(s):

Gyula Farkas ◽

László Leindler ◽

Mária Daróczi ◽

Gyula Farkas

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Long Term Follow Up

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Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis

Kazan medical journal ◽

10.17750/kmj2016-828 ◽

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.

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The Pylorus Preserving Whipple Procedure for the Treatment of Chronic Pancreatitis

Swiss Surgery ◽

10.1024/1023-9332.6.5.259 ◽

2000 ◽

Vol 6 (5) ◽

pp. 259-263 ◽

Cited By ~ 15

Author(s):

Traverso

Keyword(s):

Abdominal Pain ◽

Chronic Pancreatitis ◽

Pancreatic Head ◽

Symptomatic Patient ◽

Whipple Procedure ◽

Long Term Outcomes ◽

Long Term Follow Up ◽

New Procedures

A schema is developed that outlines criteria to consider more than medical therapy for patients with severe pancreatitis that develop disabling abdominal pain. If the symptomatic patient has severe chronic pancreatitis that reaches the Cambridge Class V "marked" stage of image severity then endotherapy is indicated. If endotherapy fails then surgery is indicated. Usually these patients will have pathological changes centered in the pancreatic head and PPW is performed. After an average follow-up of > 4 years PPW was observed to provide either good to excellent relief of disabling abdominal pain. These patients were highly selected by the guidance of the anatomic profile of the composite pancreas. Long-term follow-up has never been available with cancer patients after the Whipple procedure. These chronic pancreatitis patients after PPW showed few GI side effects. In addition we did not observe a predisposition for diabetes other than that from the continued parenchymal destruction from smoldering chronic pancreatitis in the pancreatic remnant. Surgeons should avoid total pancreatectomy in patients, even if the patient is already diabetic. Marginal ulceration is highly associated with the total resection. From this personal experience using anatomic criteria and close follow-up, it is hoped that the long term outcomes of pain relief in virtually all patients after PPW will represent a benchmark for results after procedures which employ less resection. Therapy should be based on reliable imaging criteria to select patients. Then the outcomes of new and promising procedures such as lithotripsy or limited head resections can be compared to the benchmarks derived after PPW. None of the new procedures, however address the main problem after PPW of remnant pancreatitis in the pancreatic body/tail. Even though this discomfort is no longer disabling after head resection remnant pancreatitis does occur in approximately one out of four patients.

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

Swiss Surgery ◽

10.1024/1023-9332.6.5.254 ◽

2000 ◽

Vol 6 (5) ◽

pp. 254-258 ◽

Cited By ~ 2

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.

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Long-term follow-up after organ-preserving pancreatic head resection for chronic pancreatitis in 150 patients

Zeitschrift für Gastroenterologie ◽

10.1055/s-2008-1079618 ◽

2008 ◽

Vol 46 (05) ◽

Author(s):

G Farkas ◽

L Leindler ◽

M Daróczi ◽

G Farkas Jr

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Long Term Follow Up

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

The American Surgeon ◽

10.1177/000313481508100927 ◽

2015 ◽

Vol 81 (9) ◽

pp. 909-914 ◽

Cited By ~ 10

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.

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