The Pylorus Preserving Whipple Procedure for the Treatment of Chronic Pancreatitis

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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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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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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Redo Surgery After Duodenum-Preserving Pancreatic Head Resection for Chronic Pancreatitis: High Incidence in Long-Term Follow-up

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-015-2791-6 ◽

2015 ◽

Vol 19 (6) ◽

pp. 1078-1085 ◽

Cited By ~ 5

Author(s):

Sebastian Zach ◽

Torsten J. Wilhelm ◽

Felix Rückert ◽

Florian Herrle ◽

Marco Niedergethmann

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Redo Surgery ◽

High Incidence ◽

Long Term Follow Up

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Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis

British Journal of Surgery ◽

10.1002/bjs.5960 ◽

2008 ◽

Vol 95 (3) ◽

pp. 350-356 ◽

Cited By ~ 73

Author(s):

M. W. Müller ◽

H. Friess ◽

D. J. Martin ◽

U. Hinz ◽

R. Dahmen ◽

...

Keyword(s):

Clinical Trial ◽

Chronic Pancreatitis ◽

Randomized Clinical Trial ◽

Whipple Procedure ◽

Long Term Follow Up

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Management of Canine Y-T Humeral Fractures Using Titanium Polyaxial Locking Plates in 17 Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-7155 ◽

2022 ◽

Vol 58 (1) ◽

pp. 7-16

Author(s):

Claudio Motta ◽

Philip Witte ◽

Andrew Craig

Keyword(s):

Functional Impairment ◽

Complication Rates ◽

Load Testing ◽

Inclusion Criteria ◽

Long Term Outcomes ◽

Long Term Follow Up ◽

Mild Impairment ◽

Condylar Fractures

ABSTRACT The objective of this study was to document the short- and medium-to-long-term outcomes and complication rates of Y-T humeral condylar fractures fixed using titanium polyaxial locking plate (T-PLP). A retrospective review was performed of the medical records and radiographs of dogs with a Y-T humeral condylar fracture treated with T-PLP at a single veterinary referral center (2012–2018). Seventeen cases met the inclusion criteria. Medium- to long-term follow-up (.6 mo) information was derived using the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Recorded complications were catastrophic (1/17) and minor (2/17). Gait at 10–12 wk following surgery was subjectively assessed as good or excellent for 13 cases. Radiographic bone union was achieved in 7/12 cases at 4–6 wk. LOAD scores obtained a mean of 15 mo (range 6–29 mo) following surgery and indicated no or mild impairment in 15/16 and moderate functional impairment in 1. The application of T-PLP for the treatment of Y-T humeral condylar fractures resulted in adequate stabilization allowing successful fracture healing and medium- to long-term outcomes comparable to previous reports. According to results of LOAD testing, the medium- to long-term follow-up suggests that clients were aware of mild to moderate functional impairment in all cases.

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Insulinoma and Chronic Kidney Disease: An Uncommon Conundrum Not to Be Overlooked

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.1177/1179551417742620 ◽

2017 ◽

Vol 10 ◽

pp. 117955141774262 ◽

Cited By ~ 2

Author(s):

Luca Foppiani ◽

Serena Panarello ◽

Marco Filauro ◽

Maria Concetta Scirocco ◽

Stefano Cappato ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Pancreatic Head ◽

Small Region ◽

Uncinate Process ◽

Positron Emission ◽

Long Term Follow Up ◽

Histology And Immunohistochemistry

A hypertensive man with chronic kidney disease (CKD) secondary to polycystic disease was hospitalized for symptoms related to hypoglycemia. Fasting test elicited symptomatic hypoglycemia after 12 hours, which was associated with inappropriately unsuppressed normal insulin and C-peptide levels. Neither ultrasonography (US) nor magnetic resonance imaging detected any pancreatic tumor. Endoscopic ultrasonography (EUS) showed a small isoechogenic nodule suspect for neuroendocrine tumor in the pancreatic head. 68Gallium-DOTA-Tyr3-octreotide positron emission tomography/computed tomography revealed intense uptake by a small region in the pancreatic head. Surgical exploration together with intraoperative US confirmed the nodule in the pancreatic head and evidenced another hypoechogenic one in the uncinate process. Both nodules were enucleated, but only the latter, which had not been previously detected by EUS, proved compatible with insulinoma on combined histology and immunohistochemistry. After nodule enucleation, hypoglycemia resolved and did not relapse. Insulinoma, as a major cause of unexplained hypoglycemia, requires careful hormonal and instrumental workup. In patients with CKD, the interpretation of biochemical criteria for the diagnosis of insulinoma can be challenging. Localization techniques may display pitfalls. Surgery is curative in most patients but long-term follow-up is required.

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Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.714638 ◽

2021 ◽

Vol 8 ◽

Author(s):

Congcong Luo ◽

Ruidong Qi ◽

Yongliang Zhong ◽

Suwei Chen ◽

Hao Liu ◽

...

Keyword(s):

Overall Survival ◽

Aortic Dissection ◽

Type B ◽

Frozen Elephant Trunk ◽

Long Term Outcomes ◽

Chronic Type ◽

Elephant Trunk ◽

Long Term Follow Up

Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

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