DUODENUM-PRESERVING PANCREATIC HEAD RESECTION FOR CHRONIC PANCREATITIS, BENIGN AND PREMALIGNANT TUMORS OF THE PANCREAS

Objective. To report the institutional experience of the evolution of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for chronic pancreatitis with an inflammatory tumor as well as cystic and benign, premalignant neoplasms and neuroendocrine tumors of the pancreatic head. Methods. DPPHR is associated with preservation of gastric antrum, common bile duct and duodenum/upper jejunal loop, contrary to Kausch-Whipple resection, which is a multivisceral procedure, including duodenectomy. Duodenum-preserving pancreatic head resection was first established in clinical setting in Berlin in 1969. Results. For chronic pancreatitis with an inflammatory infiltrat in the pancreatic head, duodenum-preserving pancreatic head resection has become a standard surgical treatment with worldwide acceptance. In a series of 603 patients with chronic pancreatitis following DPPHR, the frequency of pancreatic fistula was 3.3 %, intra-abdominal abscess 2.8 %, hemorrhage 2.8 %, frequency of reoperation 5.6%, in-hospital mortality 0.82 % and 90-day rehospitalisation 8 %. DPPHR for benign and premalignant cystic neoplasms of the pancreatic head is used predominantly for IPMN, MCN and SPN tumors. In a review of international publications comprising 503 patients, the general morbidity was 38.2 %, severe surgery-related complications 12.7% of them pancreatic fistula B+C 13.6 %, resurgery 2.7 % and 90-day mortality 0.4 %. When pancreatic neuroendocrine tumors of pancreatic head are treated with DPPHR, a local lymph node dissection is additionally recommended. The long-term morbidity following DPPHR revealed new onset of diabetes mellitus and exocrine dysfunctions in only 5-7 % of patients. Conclusion. Kausch-Whipple resection is associated with considerable high metabolic complications. Duodenum-sparing pancreatic head resection for inflammatory tumor, benign and premalignant neoplasms, and neuroendocrine tumors of the pancreatic head has the advantage of the duodenum preservation and maintenance of the pancreatic endocrine and exocrine functions.

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Limited Parenchyma-Sparing Pancreatic Head Resection for Benign Neuroendocrine Tumors and Cystic Neoplasms—the Use of Duodenum-Preserving Head Resection

Indian Journal of Surgery ◽

10.1007/s12262-019-01971-8 ◽

2019 ◽

Vol 82 (3) ◽

pp. 371-376

Author(s):

Daniel Gavrila ◽

Monica Lacatus ◽

Hans G. Beger ◽

Stefan Tudor ◽

Catalin Vasilescu

Keyword(s):

Neuroendocrine Tumors ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Cystic Neoplasms ◽

Parenchyma Sparing

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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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Surgical Treatment of Pancreas Divisum Causing Chronic Pancreatitis: The Outcome Benefits of Duodenum-Preserving Pancreatic Head Resection

Journal of Gastrointestinal Surgery ◽

10.1016/j.gassur.2004.11.009 ◽

2005 ◽

Vol 9 (5) ◽

pp. 710-715 ◽

Cited By ~ 20

Author(s):

W SCHLOSSER ◽

B RAU ◽

B POCH ◽

H BEGER

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Pancreas Divisum ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Pancréas Divisum

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Duodenum-preserving Pancreatic Head Resection Versus Pancreatoduodenectomy for Surgical Treatment of Chronic Pancreatitis

Annals of Surgery ◽

10.1097/sla.0b013e3181724ee7 ◽

2008 ◽

Vol 247 (6) ◽

pp. 950-961 ◽

Cited By ~ 114

Author(s):

Markus K. Diener ◽

Nuh N. Rahbari ◽

Lars Fischer ◽

Gerd Antes ◽

Markus W. Büchler ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Pancreatic Head ◽

Pancreatic Head Resection

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Ten-Year Experience With Duodenum and Organ-Preserving Pancreatic Head Resection (Büchler-Farkas Modification) in the Surgical Treatment of Chronic Pancreatitis

Pancreas ◽

10.1097/mpa.0b013e3181d3727b ◽

2010 ◽

Vol 39 (7) ◽

pp. 1082-1087 ◽

Cited By ~ 5

Author(s):

Gyula Farkas ◽

László Leindler ◽

Mária Daróczi ◽

Gyula Farkas

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Pancreatic Head ◽

Pancreatic Head Resection

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RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS AND THE RISK OF CANCER AFTER SURGICAL TREATMENT

Problems in oncology ◽

10.37469/0507-3758-2018-64-2-228-233 ◽

2018 ◽

Vol 64 (2) ◽

pp. 228-233

Author(s):

Vladimir Lubyanskiy ◽

Vasiliy Seroshtanov ◽

Ye. Semenova

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Surgical Treatment ◽

Fibrous Tissue ◽

Pancreatic Head ◽

Head Region ◽

Intestinal Anastomoses ◽

Resection Of The Pancreas ◽

Risk Of Cancer

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

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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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The substantiation of chronic pancreatitis surgical treatment method selection

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2007-3-43-50 ◽

2007 ◽

Vol 6 (3) ◽

pp. 43-50

Author(s):

V. A. Koubyshkin ◽

I. A. Kozlov ◽

N. I. Yashina ◽

T. V. Shevchenko

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Gastric Resection ◽

Clinical Manifestations ◽

Pancreatic Head ◽

Pain Syndrome ◽

Treatment Method ◽

Pancreas Head ◽

Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

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