scholarly journals Drainage procedures for small duct disease in chronic pancreatitis: a feasible option

2018 ◽  
Vol 5 (6) ◽  
pp. 2319
Author(s):  
Venkatarami Reddy Vutukuru ◽  
Raghavendra Rao R. V. ◽  
Varughese Mathai ◽  
Sarala Settipalli
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Intractable Pain ◽  
Disease Group ◽  
Preoperative Pain ◽  
Exocrine Insufficiency ◽  
Pain Scores ◽  
Small Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Feasible Option

Background: Surgery is the treatment of choice for intractable pain in chronic pancreatitis (CP). Drainage procedures are indicated in large duct disease whereas resectional procedures for small duct disease. Aim of this study was to assess prospectively the feasibility of drainage procedures in patients with CP with small duct disease.Methods: All consecutive patients with CP with small duct disease were included in the study. All patients underwent surgical intervention (lateral pancreaticojejunostomy with head coring). Primary outcome measures were pain relief and morbidity. These outcomes were compared with patients with CP with large duct disease.Results: 114 patients with CP underwent surgery. Of these 24(21.05%) patients had CP with small duct disease and 90(78.95%) patients had large duct disease. Demographic profile of the two groups was comparable. Mean pain scores were similar (47.75±6.85 versus 51.38±7.40; p = 0.14). Patients with large duct disease had higher incidence of diabetes mellitus (44.44% versus 8.33%; p = 0.02), but exocrine insufficiency was similar. All patients had calcifications in both the groups. Mean intraductal pressures measured intraoperatively were significantly high in patients with large duct disease (22.99±5.65 versus 18.33±3.52; p = 0.001). Frequency of complications at presentation were similar in both the groups (p = 0.29). Surgery relieved pain in 21/24 (87.5%) patients with small duct disease and 82/90 (91.11%) patients with large duct disease. Mean post-operative pain scores in small duct disease group (7.50±9.61 versus 51.38±7.40; p <0.001) and large duct disease group (5.14±7.88 versus 47.75±6.85; p <0.001) were significantly reduced when compared to preoperative pain scores. Incidence of postoperative complications was similar in both groups (16.66% versus 14.44%).Conclusions: Drainage procedures (lateral pancreaticojejunostomy with head coring) is a feasible for CP patients with small duct disease with good pain relief. 

scholarly journals 556 A Prospective Review of Risk Factors, Clinical Presentation and Management Outcomes for Chronic Pancreatitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Akula ◽  
K Sugumar ◽  
A Deshpande
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Duct ◽  
Statistical Correlation ◽  
Pain Severity ◽  
Female Ratio ◽  
Pain Scores ◽  
Duct Diameter ◽  
Imaging Characteristics

Abstract Aim and objectives: To identify the risk factors, symptoms, and severity of Chronic pancreatitis (CP) on admission. To determine the relationship between pancreatic duct diameter and severity of pain and to assess extent of pain relief achieved by medical, endoscopic, and surgical intervention. Method 75 patients with CP were admitted over 2 years. Data collected included etiology, symptoms, pain scores and CT/MRCP findings. Patients were classified into mild, moderate, and severe category according to Cambridge classification. Type and response to treatment was recorded. Statistical correlation of the pancreatic duct diameter and pain severity as well as the comparison of pain scores after medical, surgical and endoscopy was performed using Chi square test (p value &lt;0.05) Results Median age of presentation of CP was 43 years. Male: female ratio was 3:1. Alcohol was the etiology in 66 %, 99% presented with pain, 65 % belonged to severe category. There was no statistical correlation between pain severity and duct diameter. Pain relief following medical management was 66 %, endoscopic - 73% and surgical - 83 %. There was no correlation between Cambridge classification and pain severity. There was no statistical difference between pain relief offered by either of the three modalities. However, there was a statistically significant correlation between duct diameter and type of intervention. Conclusions There is no consensus on the best treatment modality for CP as pain relief was equivalent amongst all the modalities. Therefore, the choice of intervention for patients suffering from chronic pancreatitis should be based on imaging characteristics and symptomology.

scholarly journals A prospective study of prognostic factors predicting outcome of surgery in chronic pancreatitis at a tertiary care centre in India

2021 ◽  
Vol 11 (2) ◽  
pp. 182-186
Author(s):  
Satya Prasad Samantaray ◽  
Tanmay Dutta
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pain Score ◽  
Scoring System ◽  
Tertiary Care ◽  
Insulin Requirement ◽  
Tertiary Care Centre ◽  
Exocrine Insufficiency ◽  
Endocrine Insufficiency ◽  
Outcome Of Surgery

Identification of factors predicting the outcome of surgery for chronic pancreatitis and preparation of a scoring system to predict the outcome following surgery. A total number of 76 patients who had undergone surgery for chronic pancreatitis were prospectively followed at Department of General Surgery, S.C.B. Medical College, Cuttack during the period from 2010-2013. Data on demographic details, pain score, opioid addiction, exocrine and endocrine insufficiency, insulin requirement and morphology of pancreas on imaging were recorded. On follow up, improvement in pain score and exocrine and endocrine insufficiency were recorded. Factors affecting surgical outcome were determined and a scoring system was done. The mean age of patients was 39.7±7.9 years (range 18-58 years). Chronic alcohol intake was the predominant cause accounting for 56% (n=34) cases. Mean pain score at admission on Visual Analogue Scale (VAS) was 5.98. Twenty-six patients (43.3%) were found to have endocrine insufficiency and 22 (36.6%) patients had exocrine insufficiency. Forty-two patients underwent Partington-Rochelle procedure, and 18 patients underwent Frey’s procedure. Eighty percent of patients (n=48) had significant pain relief. On logistic regression, preoperative VAS score, number of previous admissions, opioid dependence, main pancreatic duct (MPD) diameter, number and site of calcifications were found to be significant in predicting pain relief. Cohort of patients with chronic pancreatitis likely to get benefit from surgery can be predicted preoperatively.

scholarly journals Outcome of Pancreatic Head Coring in as Key Surgical Treatment in Head Dominant Chronic Pancreatitis in Tertiary Referral Centers of Bangladesh

2018 ◽  
Vol 8 (2) ◽  
pp. 151-158
Author(s):  
Hashim Rabbi ◽  
Md Mamunur Rashid ◽  
AHM Tanvir Ahmed ◽  
HM Sabbir Raihan ◽  
Sarder Rizwan Nayeem ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pancreatic Head ◽  
Endocrine Function ◽  
Intractable Pain ◽  
Frey’S Procedure ◽  
Management Protocol ◽  
Lateral Pancreaticojejunostomy

Background: Pancreatic head coring procedure, an organ preserving surgery in which diseased head of pancreas is cored with drainage of main pancreatic duct by lateral pancreatico-jejunostomy. Chronic pancreatitis is a persistently occurring inflammatory disease that causes pancreatic duct stones or calcification, stricture, dilatation of pancreatic duct and irreversible morphological changes resulting intractable pain and losses of exocrine and endocrine function. Appropriate management protocol recognizing underlying pathology, can prevent complications and improves the quality of life. Apart from ductal decompression, in Frey’s’ procedure resection of the “pacemaker of pain” (Head of the pancreas) gives excellent outcome.Methods: In this prospective observational study, we have intended to further validate the Frey’s procedure an effective surgical method in head dominant severe chronic pancreatitis. The study was carried out on 106 Bangladeshi patients who underwent Frey’s Procedure with Lateral Pancreaticojejunostomy from January 2000 to December 2017.Result: The study revealed 51 patients (48.11%) were in 3rd decade of life with 45 male and 61 female. We found 77 patients presented with diabetes mellitus, mostly on insulin. Steatorrhoea was noted in 39 patients and Malnutrition in 79 patients. Visual Analog Scale (VAS) was used for scoring pain. Postoperative morbidity was noted in 29 patients 27.35 % cases, but there was no anastomotic leakage or mortality in the immediate postoperative period in our series.Conclusion: Quality of life has always been the most important decisive factor for patients with severe chronic Pancreatitis. Pain is the predominant clinical feature and very difficult to control. Correction of diabetes and malnutrition are major challenges too. This study revealed, Frey’s procedure with adequate ductal clearance with wide pancreato-jejunal anastomosis in head dominant severe chronic pancreatitis is key to better pain control, improves quality of life and prevents recurrence.Birdem Med J 2018; 8(2): 151-158

scholarly journals A clinical study on lateral pancreaticojejunostomy in a case of chronic pancreatitis

2021 ◽  
Vol 8 (5) ◽  
pp. 1617
Author(s):  
Suhas B. Manapure ◽  
Anil S. Munde ◽  
Ravibhushan J. Kasale ◽  
Pramod Lokare
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Duct ◽  
Anastomotic Leak ◽  
Pancreatic Insufficiency ◽  
Drainage Procedure ◽  
Health Care Centre ◽  
Lateral Pancreaticojejunostomy

Lateral pancreaticojejunostomy is a seldom performed procedure in a peripheral tertiary health care centre. Very few numbers of cases are reported that undergoes surgical procedures for chronic pancreatitis. We report a such rare case in our institute that undergone pancreatic drainage procedure. A 70 year old poor patient was admitted in our institute with a complaint of chronic abdominal pain, subsequently diagnosed to be having chronic pancreatitis with complications with pancreatic duct calculus. Pancreatic drainage procedure, lateral pancreaticojejunostomy was performed and we analysed for the outcome of the procedure with regards to pain relief, anastomotic leak, quality of life and return to work. Patient recovered well post-operatively, reported pain relief, suffered no anastomotic leak and experienced improved quality of life. Lateral pancreaticojejunostomy provides excellent surgical choice for patients of chronic pancreatitis with pancreatic duct calculus with acceptable rates of pain relief, morbidity and mortality, without worsening pancreatic insufficiency. 

scholarly journals Epidural analgesia for intractable cancer pain - An old story used until now

2020 ◽  
Vol 12 (2) ◽  
pp. 15-24
Author(s):  
Marija Sholjakova ◽  
Biljana Kuzmanovska ◽  
Vesna Durnev ◽  
Adrijan Kartalov ◽  
Rozalinda Isjanovska
Keyword(s):  
Pain Relief ◽  
Epidural Analgesia ◽  
Cancer Pain ◽  
Intractable Pain ◽  
Morphine Group ◽  
Urine Retention ◽  
Pain Scores ◽  
Chronic Severe Pain ◽  
Intractable Cancer Pain ◽  
The University

Intractable cancer pain is a chronic severe pain, affecting patient’s quality of life and presents aheavy health, social and family problem in many countries. Different methods for pain relief are proposed by the WHO. Epidural analgesia with opioids is one of the proposed methods. Aim of the study was to determine the effects of morphine, fentanyl and butorphanol used for epidural analgesia in intractable pain and to comment our experiences over a five-year-period, with regard to its actuality nowadays. Material and methods: Retrospective longitudinal observational study was carried at the University Clinic for Anesthesiology, Reanimation and Intensive Care in Skopje, Macedonia, between 2005-2010 and evaluated in 2017-2018. A total of 116 patients suffering from intractable pain were enrolled in the study. Exclusion criteria were: infective and metastatic processes in the spine, allergy to opioids, psychological problems and language barrier. After the pretreatment evaluation of the pain, patients were randomly assigned to receive three different opioids through epidural catheter placed from Th8-10 or L2-3. Results: There were no differences in pretreatment pain scores between the three groups (p>0.05). A significant onset of analgesia after 15 minutes was found for butorphanol, 20 minutes for fentanyl and 30 minutes for morphine group (p<0.05). The duration of the pain relief of butorphanol vs. fentanyl vs. morphine was 6h vs. 8h vs. 24 hours respectively.  Morphine had the longest duration of pain relief (p<0.05). Because of an increase in the pain threshold, the need of an increase of opioid doses was necessary. The most often patient’s reports of side effects were: itching, constipation, urine retention and bradypnea and there were no reports of nausea and vomiting. Conclusions: It was concluded that epidural analgesia with opioids is an effective and safe method for suppression of intractable pain.  In spite of the other alternatives in treatment of cancer pain, epidural analgesia with opioids still has an eminent place and its use is a challenge for professionals

scholarly journals Clinical characteristics and quality of life among Sri Lankan patients with chronic pancreatitis

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097987
Author(s):  
Umesh Jayarajah ◽  
Thisaru Widyarathne ◽  
Metthananda Nawarathne ◽  
Sivananthan Raguvaran ◽  
Nishanthan Subramaniam ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Chronic Pancreatitis ◽  
Clinical Characteristics ◽  
Considerable Proportion ◽  
Intractable Pain ◽  
Life Questionnaire ◽  
European Organization ◽  
Loss Of Appetite

Objective We aimed to describe the clinical characteristics of chronic pancreatitis (CP) and patient quality of life (QOL) in a resource-limited setting. Methods We performed a cross-sectional study including patients with clinical and radiological features of CP. We collected clinical data and assessed QOL using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. Results We included 103 patients (median age 44 years, 84 men). Median age at symptom onset was 36 (4–78) years. Around 70% of patients had diabetes mellitus and 62.1% had consumed alcohol; 36 (35%) were current smokers. The mean overall global QOL score was 68.7. Most patients (91.3%) sought treatment from multiple centers. Nineteen (18.5%) had pancreatic stone disease, 38 (36.9%) had persistent abdominal pain (median severity 7.8/10, 59 (57.3%) had steatorrhea, and 56 (54.4%) had jaundice. Poor QOL was significantly associated with weight loss, loss of appetite, and intractable pain. No correlation with age, sex, or alcohol consumption was noted. Conclusion A considerable proportion of patients with CP had troublesome symptoms. Intractable pain, loss of appetite, and weight loss were significantly associated with poor QOL. Further assessment is needed of patients’ psychosocial well-being and its association with QOL.

scholarly journals Predicted Versus Non-Predicted Opioid Administration Using Preoperative Pain Sensitivity in Patients Undergoing Gynecological Surgery: A Randomized-Controlled Trial

2021 ◽  
Vol 10 (4) ◽  
pp. 585
Author(s):  
Sun-Kyung Park ◽  
Hansol Kim ◽  
Seokha Yoo ◽  
Won Ho Kim ◽  
Young-Jin Lim ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Sensitivity ◽  
Control Group ◽  
Gynecological Surgery ◽  
Control Groups ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Pressure Pain Thresholds ◽  
Opioid Administration ◽  
And Control

Individualized administration of opioids based on preoperative pain sensitivity may improve postoperative pain profiles. This study aimed to examine whether a predicted administration of opioids could reduce opioid-related adverse effects after gynecological surgery. Patients were randomized to the predicted group or control group. Participants received a preoperative sensory test to measure pressure pain thresholds. Patients were treated with a higher or lower (15 or 10 μg/mL) dose of fentanyl via intravenous patient-controlled analgesia. The opioid dose was determined according to pain sensitivity in the predicted group, while it was determined regardless of pain sensitivity in the control group. The primary outcome was the incidence of nausea over the first 48 h postoperative period. Secondary outcomes included postoperative pain scores and opioid requirements. There was no difference in the incidence of nausea (40.0% vs. 52.5% in predicted and control groups, respectively; p = 0.191) and postoperative pain scores (3.3 vs. 3.5 in predicted and control groups, respectively; p = 0.691). However, opioid consumptions were lower in the predicted group compared to the control group (median 406.0 vs. 526.5 μg; p = 0.042). This study showed that offering a predicted dose of opioids according to pain sensitivity did not affect the incidence of nausea and pain scores.

Sign in / Sign up

Export Citation Format

Share Document