scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

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.

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

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.

scholarly journals Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis

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.

STENOSIS OF THE CELIAC TRUNK – FROM DIAGNOSTICS TO TREATMENT

2018 ◽  
pp. 68-77
Author(s):  
O. A. Afukova ◽  
A. L. Yudin ◽  
A. Yu. Razumovskiy
Keyword(s):  
Surgical Treatment ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Celiac Trunk ◽  
Treatment Method ◽  
Diagnostic Methods ◽  
Mesenteric Arteries ◽  
Optimal Method ◽  
Ultrasound Technique ◽  
Abdominal Organs

Compression stenosis of the celiac trunk (CSCT) is a syndrome based on the celiac trunk stenosis of varying degree, sometimes in combination with that of the superior mesenteric artery, caused by the compression of this vessel by the medial arched ligament of the diaphragm, as well as its internal legs and the neurofibrotic tissue of the celiac plexus. CSCT can cause chronic ischemia of the abdominal organs and chronic pain syndrome. The branches of the celiac trunk, supplying the stomach, liver, pancreas to the blood, are connected with the mesenteric arteries of the intestine in a common circle, therefore, with a lack of blood flow along one of the branches, the entire digestive tract suffers . The main clinical manifestation of CSCT is abdominal pain, observed in 97–100% patients. Angiography is the most invasive and, at the same time, the most informative method currently available to assess the extent and degree of the celiac trunk narrowing and to determine indications for surgical treatment. Ultrasound is a harmless, painless and at the same time informative diagnostic method for CSCT. A modern ultrasound technique is ultrasound with the use of echocontrast. Multi-detector CT angiography with multiplanar and 3D reconstruction is the optimal method of X-ray diagnostics of CSCT. MR angiography is successfully used both for preoperative preparation in patients with compression of the celiac trunk, and in the postoperative period. The methods of surgical treatment for abdominal ischemia are divided into palliative, decompressional and reconstructive. Modern diagnostic methods allow non-invasive methods to diagnose CSES in combination with clinical manifestations. The laparoscopic method is optimal for celiac trunk decompression, but the choice of the surgical treatment method should be considered individually.

scholarly journals Alveolar Echinococcosis in Children

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Emilija Jonaitytė ◽  
Martynas Judickas ◽  
Eglė Tamulevičienė ◽  
Milda Šeškutė
Keyword(s):  
Surgical Treatment ◽  
Current Literature ◽  
Echinococcus Multilocularis ◽  
Cystic Echinococcosis ◽  
Alveolar Echinococcosis ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Methods

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.

Evaluation of Metatarsal Head Resurfacing Hemiarthroplasty in the Surgical Treatment of Hallux Rigidus: A Retrospective Study and Mid- to Long-Term Follow-up

2017 ◽  
Vol 11 (1) ◽  
pp. 22-31 ◽  
Author(s):  
Musa Uğur Mermerkaya ◽  
Erkan Alkan ◽  
Mehmet Ayvaz
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Treatment Method ◽  
Hallux Rigidus ◽  
Retrospective Case ◽  
First Metatarsophalangeal Joint

Background. The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. Methods. We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). Results. The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). Conclusions. First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes. Levels of Evidence: Level IV: Retrospective case series

scholarly journals Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Francesco Stipa ◽  
Adolfo Gavelli ◽  
Claude Huguet
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Pancreatic Resection ◽  
Pancreatic Head ◽  
Postoperative Mortality ◽  
Arterial Embolization ◽  
Arterial Ligation ◽  
Post Traumatic

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future.

scholarly journals The results of surgical treatment of patients with lumbosacral radiculopathy, caused by paraarticular and disc cysts

2019 ◽  
Vol 21 (2) ◽  
pp. 63-69
Author(s):  
M N Kravtsov ◽  
D V Pomet'ko ◽  
V I Leonov ◽  
B V Gaydar ◽  
D V Svistov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Surgical Treatment ◽  
Lumbar Spine ◽  
Magnetic Resonance ◽  
Average Duration ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Subjective Assessment ◽  
Resonance Imaging ◽  
Hospitalization Period

The results of the conservative and surgical treatment of 12 patients at the Neurosurgery Clinic of the Military medical academy. CM. Kirov, in the period 2016-2018, about the paraarticular and disc cysts of the lumbar spine. Performed open microsurgical and full-endoscopic operational aids. Evaluation of the effectiveness of surgical treatment was carried out using the subjective assessment scale and magnetic resonance imaging over time. The follow-up period ranged from 6 to 24 months. Most often, extradural cysts were located at the level of the LIV-LV segment. Clinical manifestations were characterized by radiculopathy and local back pain. The average duration of pain syndrome was 3±0,7 months. Conservative treatment led to a regression of pain and resorption of a disk cyst in one patient. In other cases, surgical treatment was required. The average duration of a microsurgical operation was 131,6±73,4 minutes, video endoscopic - 80±10,8 minutes. The hospitalization period in the group of microsurgical treatment was 10,4 days, in the group of video endoscopy - 4,7 days. Control magnetic resonance imaging revealed the recurrence of paraarticular cysts in the area of the previous operation in 3 patients. Relapse in patients with disc cysts is not marked. Necessity in repeated operations did not arise in one supervision. It has been established that the main clinical manifestations of extradural cysts of the lumbar spine are local moderate pain, radiculopathy, and intermittent claudication. Microsurgical and percutaneous video endoscopic treatment of lumboischialgia due to extradural cysts is significantly more effective compared with conservative therapy. Full-endoscopic interventions in comparison with microsurgical ones are less invasive and long-lasting and can reduce the time of inpatient treatment.

scholarly journals Modern principles of surgical treatment of chronic pancreatitis

2019 ◽  
pp. 306-312
Author(s):  
Volodymyr Kopchak ◽  
Mykhailo Nychytailo ◽  
Oleksandr Duvalko ◽  
Vasyl Khanenko ◽  
Volodymyr Trachuk ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Pancreatic Duct ◽  
Surgical Techniques ◽  
Surgical Interventions ◽  
Distal Pancreatic Resection ◽  
Initial Surgery ◽  
Beger Procedure ◽  
Repeated Surgery ◽  
Resection Of The Pancreas

We reviewed the charts of 752 patients, who have undergone surgery for various forms of chronic pancreatitis at “Shalimov’s National Institute of Surgery and Transplantation of the NAMS of Ukraine” in the years from 2007 to 2017. The average age of the 591 males (78,6 %) and 161 females (22,4 %) was 43,0 ± 3,2 years. Out of these, 446 (62,4 %) patients with pseudocysts and pancreatic fistula and also with isolated main pancreatic duct lithiasis underwent drainage procedures. The 269 (37.6%) patients were subjected to different types of resection, including the Frey operation, pancreatoenterostomy with artificial pancreatic duct formation, the Berne technique, the Beger procedure, pancreatoduodenectomy, distal-pancreatic resection and other procedures. After pancreatic resections, the patients did not require repeated surgical interventions for chronic pancreatitis. In some cases of chronic pancreatitis, there was an isolated lesion of the pancreas: in such cases (13 patients), we performed distal resection of the pancreas. Among the observed patients here were no fatal cases. Satisfactory results were obtained in 92.6 % of cases at longterm follow-up. Post-operative complications occurred in 27 patients (4.6 %), in 6 (1.03 %) patients there was a need for repeated surgery. Progression of the disease in patients previously operated in our clinic was observed in 32 (5.5 %), and 72 patients, initially operated in other medical institutions. Patients after direct resection of the pancreas did not require repeated surgery for chronic pancreatitis. The main causes of unsatisfactory results of the surgical treatment for chronic pancreatitis have been found to be: false indications for initial surgery, improper primary surgical techniques, insufficient use of drainage procedures, as well as, performing a drainage procedure instead of a resection. Key words: chronic pancreatitis, surgical treatment, resection and drainage procedures. For citation: Usenko OY, Kopchak VM, Nychytailo MY, Duvalko OV, Khanenko VV, Trachuk VI, Khomiak AI. Modern principles of surgical treatment of chronic pancreatitis. Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):306–12

scholarly journals Comparative Analysis of the Results of Various Methods for Pancreatic Head Resection in Chronic Pancreatitis

2020 ◽  
Vol 9 (2) ◽  
pp. 238-250
Author(s):  
A. R. Propp ◽  
E. N. Degovtsov
Keyword(s):  
Chronic Pancreatitis ◽  
Comparative Analysis ◽  
Surgical Treatment ◽  
Pancreatic Head ◽  
Late Results ◽  
Controlled Study ◽  
Optimal Method ◽  
Duration Of Surgery ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.

scholarly journals Elimination of pain syndrome in patients with advanced pancreatic head cancer

2019 ◽  
Vol 42 (1) ◽  
pp. 46-52
Author(s):  
T. G. Gevorkyan ◽  
I. A. Feinstein
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Drug Therapy ◽  
Cancer Patients ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Pancreatic Head Cancer ◽  
Surgical Methods

Pain syndrome, along with mechanical jaundice, is one of the most evident clinical manifestations of pancreatic cancer and is often a sign of tumor neglecting. Existing treatment options for chronic pain in cancer patients are diverse and include the various ways of impact on the different links of pathological pain: medicinal, endoscopic, surgical. With this pathology, drug therapy using analgesics, weak and strong opioids, is usually not effective enough. In such cases, preference is given to chemical neurolysis — denervation of the autonomic structures of the retroperitoneal space, carried out under the guidance of ultrasound or computed tomography. Conducting percutaneous neurolysis of the celiac plexus with the use of alcohol or phenol is prescribed upon insufficient effectiveness of pharmacotherapy. Surgical methods of anesthesia are used extremely rarely, as they considerably worsen the patient’s condition, without significantly affecting the quality of life or the prognosis. Thoracoscopic splanchnicectomy is considered a modern and effective method of endoscopic treatment of pain in unresectable pancreatic cancer, the conduction of which can significantly decrease the intensity of pain, reduce the number of narcotic analgesics and improve the quality of life of cancer patients. This minimally invasive intervention is the basis for the subsequent lifelong systemic drug therapy.

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