Intraoperative bile duct cultures in patients undergoing pancreatic head resection: Prospective comparison of bile duct swab versus bile duct aspiration

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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A duodenum-preserving and bile duct–preserving total pancreatic head resection with associated pancreatic duct-to-duct anastomosis

Journal of Gastrointestinal Surgery ◽

10.1016/j.gassur.2003.11.007 ◽

2004 ◽

Vol 8 (2) ◽

pp. 220-224 ◽

Cited By ~ 22

Author(s):

T Takada

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Pancreatic Head ◽

Pancreatic Head Resection

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Bile duct preserving pancreatic head resection (BDPPHR): Can we conclusively define the extent of head resection in surgery for chronic pancreatitis?

Annals of Hepato-Biliary-Pancreatic Surgery ◽

10.14701/ahbps.2020.24.3.309 ◽

2020 ◽

Vol 24 (3) ◽

pp. 309-313

Author(s):

Pagadala Naga Balaji Nitesh ◽

Biju Pottakkat

Keyword(s):

Chronic Pancreatitis ◽

Bile Duct ◽

Pancreatic Head ◽

Pancreatic Head Resection

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Arteriovenous malformation in the pancreatic head initially mimicking a hypervascular mass treated with duodenum-preserving pancreatic head resection: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01075-6 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Takahiro Korai ◽

Yasutoshi Kimura ◽

Masafumi Imamura ◽

Minoru Nagayama ◽

Ayumi Kanazawa ◽

...

Keyword(s):

Bile Duct ◽

Arteriovenous Malformation ◽

Pancreatic Head ◽

Pathological Examination ◽

Resected Specimen ◽

Papilla Of Vater ◽

Pancreatic Head Resection ◽

Pancreaticoduodenal Artery ◽

Long Term Outcome ◽

First Case

Abstract Background The mainstay treatment for arteriovenous malformation in the pancreatic head (Ph-AVM) is standard pancreatectomy, especially pancreaticoduodenectomy (PD), or interventional endovascular treatment. We report the first case of Ph-AVM treated with duodenum-preserving pancreatic head resection (DPPHR) performed to preserve the periampullary organs. Case presentation A 59-year-old man presenting with back pain underwent contrast-enhanced computed tomography followed by angiography of the anterior superior pancreaticoduodenal artery. He was diagnosed with Ph-AVM and indicated for DPPHR with preservation of the periampullary organs; Ph-AVM’s benign nature seldom requires lymph node dissection. During the operation, the right colon was mobilized and the omental bursa was released to expose the periampullary structures. The pancreas was transected just above the superior mesenteric vein. The inferior pancreaticoduodenal artery and papillary arteries branching from the posterior superior pancreaticoduodenal artery were carefully preserved to maintain the blood flow to the lower bile duct and papilla of Vater. The remnant pancreas was reconstructed with pancreaticogastrostomy using the modified Blumgart method. Pathological examination of the resected specimen revealed an irregular course of the arteries and veins concomitant with marked dilation throughout the pancreatic head. The patient was pathologically diagnosed with Ph-AVM. He developed hematemesis caused by a rupture of the pseudoaneurysm on postoperative day 20 and underwent coil embolization. A bilio-enteric fistula and stenosis of the common bile duct were found and treated by placement of an endoscopic biliary stent. At the 8-month follow-up, the Ph-AVM had not recurred. Conclusions Compared to PD, DPPHR confers the clinical benefit of preserving the periampullary organs, although further studies are needed to confirm this. Therefore, the choice of this procedure should be based on the surgical morbidities and long-term outcome of the patient.

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Vascular anomalies in pancreatic head resection do not impact surgical outcome in high volume center

HPB ◽

10.1016/j.hpb.2020.11.755 ◽

2021 ◽

Vol 23 ◽

pp. S299

Author(s):

I. Frigerio ◽

S. Mancini ◽

V. Allegrini ◽

A. Giardino ◽

P. Regi ◽

...

Keyword(s):

Surgical Outcome ◽

Pancreatic Head ◽

High Volume ◽

Vascular Anomalies ◽

Pancreatic Head Resection ◽

High Volume Center

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The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study

Innovative Surgical Sciences ◽

10.1515/iss-2020-0021 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Georgi Kalev ◽

Christoph Marquardt ◽

Herbert Matzke ◽

Paul Matovu ◽

Thomas Schiedeck

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Pancreatic Head ◽

Suture Technique ◽

Postoperative Pancreatic Fistula ◽

Intermediate Care ◽

Pancreatic Head Resection ◽

Pancreatic Anastomosis

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

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Endoscopic Ultrasonography

10.2310/tywc.5504 ◽

2018 ◽

Author(s):

Marvin Ryou ◽

Nitkin Kumar

Keyword(s):

Chronic Pancreatitis ◽

Bile Duct ◽

Endoscopic Ultrasonography ◽

Fine Needle Aspiration ◽

Biliary Drainage ◽

Bile Duct Stone ◽

Pancreatic Head ◽

Needle Aspiration ◽

Celiac Plexus ◽

Fine Needle

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions. Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst This review contains 12 highly rendered figures, 2 tables, and 62 references.

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