scholarly journals Immediate and Long-Term Results of Original Methods of Longitudinal Pancreatojejunostomy With The Expansion of the Area of Pancreatojejunal Anastomosis

2020 ◽  
Vol 9 (1) ◽  
pp. 35-45
Author(s):  
A. R. Propp ◽  
E. N. Degovtsov ◽  
S. A. Nikulina
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Pancreatic Head ◽  
Main Group ◽  
Long Term Results ◽  
Hospital Treatment ◽  
Enzyme Preparations

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.

Multiple Stenting of Refractory Pancreatic Duct Strictures in Severe Chronic Pancreatitis: Long-term Results

Endoscopy ◽  
2006 ◽  
Vol 38 (03) ◽  
pp. 254-259 ◽  
Author(s):  
G. Costamagna ◽  
M. Bulajic ◽  
A. Tringali ◽  
M. Pandolfi ◽  
A. Gabbrielli ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Long Term Results

3801 Complete disruption of main pancreatic duct: short and long term results of endoscopic management.

2000 ◽  
Vol 51 (4) ◽  
pp. AB138
Author(s):  
Rungsun Rerknimitr ◽  
Stuart Sherman ◽  
Evan L. Fogel ◽  
Susan D. Phillips ◽  
Benedict M. Devereaux ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Long Term Results ◽  
Endoscopic Management ◽  
Complete Disruption ◽  
Short And Long Term

scholarly journals Criteria for the Selection of Diagnostic Signs of Chronic Pancreatitis with Obstruction of the Main Pancreatic Duct

2020 ◽  
Vol 13 (2) ◽  
pp. 76-85
Author(s):  
Alexander R Propp ◽  
Evgeny Nikolaevich Degovtsov
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Structural Changes ◽  
Early Stage ◽  
Pancreatic Head ◽  
Diagnostic Methods ◽  
Entire Length ◽  
Diagnostic Signs ◽  
Selection Of

Introduction. Clinical outcomes of surgery for patients with chronic pancreatitis (CP), considering low rates of 10-year survival, are often unsatisfying for surgeons. Due to the absence of common diagnostic criteria, especially at an early stage of the disease, patients of young and working age undergo surgery at different periods and with different methods. The development of optimal criteria for the selection of diagnostic signs of chronic pancreatitis will improve treatment outcomes.The aim of the study is 1) to perform a comparative assessment of the informative value of methods that specify diagnostics of CP with obstruction of the main pancreatic duct; 2) to develop criteria for the selection of diagnostic signs to highlight the main types of structural changes in the pancreas in chronic pancreatitis with obstruction of the main pancreatic duct.Materials and methods. The study included radiological findings of 231 patients with CP with obstruction of the main pancreatic duct operated from 1996 to 2018 in Omsk regional surgical hospital. X-ray investigations were performed in 120 patients, ultrasound investigations were performed in 231 patients, multislice spiral computed tomography (MSCT) was performed in 226 patients, MRI was performed in 18 patients, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients and angiography was performed in 5 patients. All patients were divided into two groups: control (n ​​= 88, until 2008) and case (n = 143, after 2008), where new methods of surgery were used and the structure of the applied diagnostic methods has been changed.Results. Ultrasound sensitivity was 74.5%, fistulography/virsungography sensitivity was 80%, MSCT sensitivity was 97.8%, MRI sensitivity was 88.9% and ERPC sensitivity was 95.5%. The use of invasive diagnostic methods in the main group of patients was minimized with the priority of MSCT. The main criteria for the selection of diagnostic signs of CP were determined as follows: obstruction of the main pancreatic duct (with localization at the level of the pancreatic head exclusively or along its entire length), dilatation of the main pancreatic duct (more than 3 mm), local damage to the pancreatic head with an increase in its size over 32 mm, cystic formations (more than 5 mm) in the projection of any part of the pancreas. The main types of structural changes in the pancreas were identified as follows: 1. CP with obstruction of the main pancreatic duct at the level of the pancreatic head exclusively; 2. CP with obstruction of the main pancreatic duct along its entire length with an increase in the size of the pancreatic head; 3. CP with obstruction of the main pancreatic duct along its entire length without an increase in the size of the pancreatic head.Conclusion. 1) MSCT has the highest sensitivity in CP diagnostics (98.6%). MRI (Magnetic Resonance Cholangiopancreatography (MRCP)) complements MSCT and replaces it in case of patients intolerance to contrast media. Indications for ERCP should be minimized. 2) The designed criteria for the selection of diagnostic signs of CP will optimize diagnostics of chronic pancreatitis with obstruction of the main pancreatic duct and highlight the main types of structural changes in the pancreas, the fact being important for validation of surgical treatment methods and techniques.

scholarly journals Unconventional Technique of Terminolateral Pancreatojejunostomy Formation

2021 ◽  
Vol 14 (1) ◽  
pp. 25-32
Author(s):  
Badri Valerievich SiguA ◽  
Vyacheslav Petrovich Zemlyanoy ◽  
Evgeny Alekseevich Zakharov ◽  
Malkhaz Yurievich Tsikoridze ◽  
Anatoliy Nikolaevich Napalkov
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Main Group ◽  
Soft Pancreas ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Novel Method

Backgraund. Pancreatoduodenal resection (PDR) is the only radical treatment for malignant tumors of the periampullary zone. The development of postoperative pancreatic fistula (POPF) is the most common complication of PDR. The main risk factors for the development of POPF are the narrow main pancreatic duct and the soft, "juicy" pancreatic parenchyma. Thus, it is the stage of formation of a pancretodigestive anastomosis that is of decisive importance for the course of the postoperative period.The aim of the study was to improve immediate surgical treatment outcomes of patients suffering from oncological diseases of the periampullary zone with a soft pancreas and a narrow pancreatic duct.Methods. A novel method to form terminolateral reservoir invagination pancreatojejunostomy has been developed and introduced into clinical practice. The results of treatment of 94 patients with tumors of the periampullary zone were analyzed. Based on preoperative radiological diagnosis and intraoperative findings, such factors of a high risk of POPF development as a soft pancreas and a narrow major pancreatic duct ( 3 mm) were detected in 23 patients (24.4%). In 11 patients who were treated in 2018-2019, a novel method of pancreato-jejunoanastomosis formation was applied. The comparison group consisted of 12 patients who received treatment in 2014-2017; a differentiated approach to the formation of a pancreatodigestive anastomosis was not applied.Results. In patients of the main group, there was a tendency to an increase in the proportion of pylorus-saving PDRs. The only statistically significant difference was the use of reservoir terminolateral pancreatojejunostomy at the reconstructive stage of surgery. Complicated postoperative course was observed in 7 (63.6%) patients of the main group and in all patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% (p 0.05) in the study group. Repeated surgery was required in 3 (27.2%) patients of the main group and 7 (58.3%) patients in the comparison group (p 0.05). The lethal outcome was recorded in 2 (18.2%) patients of the main group and in 3 (25%) in the comparison group (p 0.05).Conclusion. A soft, loose pancreas and a narrow main pancreatic duct are the most significant risk factors for complications in the postoperative period. Management of this condition requires a differentiated approach to the treatment option of pancreatodigestive anastomosis formation, depending on the characteristics of the pancreas of an individual patient. The proposed technique for the reservoir terminolateral pancreatojejunoanastomosis formation allowed statistically significantly reducing the incidence of complications from 100 to 63.6% and the incidence of postoperative pancreatic fistulas from 66.6 to 18.2% in high-risk patients..

scholarly journals ALGORITHM OF COMPLEX TREATMENT OF DESTRUCTIVE FORMS OF PULMONARY TUBERCULOSIS AND ITS RATIONALE

2021 ◽  
Vol 19 (1) ◽  
pp. 36-39
Author(s):  
Yu. A. Sheifer ◽  
◽  
I. S. Gelberg ◽  
Keyword(s):  
Drug Resistance ◽  
Pulmonary Tuberculosis ◽  
Comparison Group ◽  
Main Group ◽  
Long Term Results ◽  
Complex Treatment ◽  
Results Of Treatment ◽  
Artificial Pneumothorax ◽  
Cavity Closure

Background. In destructive forms of pulmonary tuberculosis, especially in the presence of drug resistance of mycobacteria, one of the ways to increase the effectiveness of therapy is the use of collapse therapeutic techniques in various modifications. Purpose of the study: to develop and substantiate an algorithm for complex treatment of destructive forms of pulmonary tuberculosis, using artificial pneumothorax (AP). Material and methods: A cohort of 84 people with destructive pulmonary tuberculosis was formed. It was divided into two groups: 42 patients in the main group (chemotherapy (ChT) + AP) and 42 in the comparison group (ChT). Results: an algorithm for the treatment of patients with destructive forms of pulmonary tuberculosis was formulated. Within a period of up to 6 months, abacillation was achieved in 61.9% of cases in the main group (MG), and in 18.9% (p <0.05) in the comparison group (CG). By the 10th month of treatment, the closure of decay cavities was achieved in 78.7% of cases in the MG and in 42.8% (p <0.05) in the CG. By 12 months the closure of decay cavities was observed in 92.1 and 52.4% of cases respectively (p <0.05). Conclusions: The use of the algorithm for the complex treatment of destructive forms of pulmonary tuberculosis makes it possible to achieve abacillation at an earlier time (up to 6 months - in 61.9%). It also allows to increase the frequency of cavity closure by 39.6% as well as achieve an increase in clinical cure (according to long-term results of treatment) by 23.8% and a decrease in the amplification of drug resistance and mortality by 14.3% and 11.9% correspondingly.

Duodenum-Preserving Pancreatic Head Resection: Future Standard Operation in Chronic Pancreatitis

Swiss Surgery ◽  
2000 ◽  
Vol 6 (5) ◽  
pp. 254-258 ◽  
Author(s):  
Kondo ◽  
Friess ◽  
Tempia-Caliera ◽  
Büchler
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Extrahepatic Bile Duct ◽  
Pancreatic Head ◽  
Operative Therapy ◽  
Long Term Results ◽  
Pancreatic Head Resection ◽  
Head Region ◽  
Standard Operation

As the incidence of chronic pancreatitis (CP) has risen in most industrialized countries due to increasing alcohol intake, operative therapy has gained importance, and various new operative procedures have been introduced in the past two or three decades. With pancreatic duct drainage operations, pain relief is frequently not satisfactory in long-term follow-up. Pathological studies in combination with modern molecular biology investigations, suggests that the pancreatic head is the "pacemaker" of the disease in most CP patients. Therefore, surgical procedures which aim to remove pancreatic head-related CP complications are needed in most patients. The Whipple operation, which was originally developed to treat malignancies in the pancreatic head region, follows oncological criteria and can therefore be considered surgical overtreatment in the majority of CP patients. As an alternative, the duodenum-preserving pancreatic head resection (DPPHR) was introduced by Hans Beger in 1972 to preserve the stomach, the extrahepatic bile duct and the duodenum. DPPHR is an organ-preserving surgical procedure which provides satisfactory long-term results with regard to mortality, morbidity, pain relief, weight gain and social and professional rehabilitation. Among the operations currently available, DPPHR is the best choice for a new standard operation in patients with pancreatic head-related complications.

scholarly journals 10 Fr S-Type Plastic Pancreatic Stents in Chronic Pancreatitis Are Effective for the Treatment of Pancreatic Duct Strictures and Pancreatic Stones

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ken Ito ◽  
Naoki Okano ◽  
Seiichi Hara ◽  
Kensuke Takuma ◽  
Kensuke Yoshimoto ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreatic Stones ◽  
Pancreatic Juice Cytology ◽  
Pancreatic Duct Stricture ◽  
Duct Stricture ◽  
Pancreatic Sphincterotomy

Aim. Endoscopic pancreatic stenting for refractory pancreatic duct strictures associated with impacted pancreatic stones in chronic pancreatitis cases has yielded conflicting results. We retrospectively evaluated the efficacy of endoscopic treatment in chronic pancreatitis patients with pancreatic duct strictures. Methods. Pancreatic sphincterotomy, dilatation procedures, pancreatic brush cytology, and pancreatic juice cytology were routinely performed, and malignant diseases were excluded. After gradual dilatation, a 10 Fr plastic pancreatic stent was inserted. The stents were replaced every 3 months and removed after the strictures were dilated. Statistical analyses were performed to determine the risk of main pancreatic duct restenosis. Results. Endoscopic pancreatic stents were successfully placed in 41 of a total of 59 patients (69.5%). The median duration of pancreatic stenting was 276 days. Pain relief was obtained in 37 of 41 patients (90.2%). Seventeen patients (41.5%) had recurrence of main pancreatic duct stricture, and restenting was performed in 16 patients (average placement period 260 days). During the follow-up period, pancreatic cancer developed in three patients (5.1%). Multivariate analysis revealed that the presence of remnant stones after stenting treatment was significantly associated with a higher rate of main pancreatic duct restenosis (p=0.03). Conclusion. The use of 10 Fr S-type plastic pancreatic stents with routine exchange was effective for both short-term and long-term outcomes in chronic pancreatitis patients with benign pancreatic duct strictures and impacted pancreatic stones.

scholarly journals ASSESSMENT OF EFFICACY OF THE METHOD OF PROGRAMMED IRRIGATION ASPIRATION SANATION IN COMPLEX TREATMENT OF PATIENTS WITH CHRONIC POSTTRAUMATIC OSTEOMYELITIS OF THE LONG BONES

2016 ◽  
Vol 175 (3) ◽  
pp. 40-43
Author(s):  
A. A. Glukhov ◽  
V. A. Sergeev
Keyword(s):  
Comparison Group ◽  
Main Group ◽  
The Other ◽  
Long Term Results ◽  
Long Bones ◽  
Treatment Results ◽  
Posttraumatic Osteomyelitis ◽  
Sf 36

The analysis of treatment results of 128 patients aged from 21 to 62 years old with chronic posttraumatic osteomyelitis of the long bones was made at the period from 2006 to 2013. The main group included 67 patients and the method of programmed irrigation aspiration sanation was applied for them. The comparison group consisted of 61 patients and drainage was performed for these patients using the conventional ways. The authors noted good immediate results in the main group in 56 (83,58%) out of 67 patients and in the comparison group - in 43 (70,49%) out of 61 patients. The long-term results were analyzed in 116 (90,6%) out of 128 patients in terms from two to five years after treatment. The rate of recurrences such as formation of purulent fistula were twice less in patients of the main group, than in the comparison group. According to the results of questionnaire SF-36, there was noticed, that patients of the main group got better mean indices of quality of life on all 8 scales compared with the other group.

scholarly journals “SPLIT” Pancreaticojejunostomy in the Surgical Treatment of Chronic Pancreatitis

HPB Surgery ◽  
1994 ◽  
Vol 8 (1) ◽  
pp. 9-12 ◽  
Author(s):  
W. Mulder ◽  
E. de Jong ◽  
T. M. van Gulik ◽  
L. Th. de Wit ◽  
D. J. van Leeuwen ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Pancreatic Duct ◽  
Long Term Results ◽  
Jejunal Loop

“Split” pancreaticojejunostomy is a procedure consisting of vertical transection of the pancreas and anastomosis of both sides of the cut pancreatic duct with an interposed, Roux-en-Y jejunal loop. In this paper we report the long term results of this procedure in the treatment of eight patients with chronic pancreatitis (CP).

scholarly journals Long-term results of using the sclerotherapy in the epididymal cysts treatment

2021 ◽  
Vol 14 (1) ◽  
pp. 62-67
Author(s):  
D.V. Sarkisyan ◽  
◽  
I.V. Vinogradov ◽  
◽  
Keyword(s):  
Clinical Efficacy ◽  
High Efficiency ◽  
Comparison Group ◽  
Sperm Count ◽  
Main Group ◽  
Long Term Results ◽  
Obstructive Azoospermia ◽  
Number Of Patients ◽  
Reproductive Events

Introduction. In recent years, there has been an increase in the number of patients diagnosed with epididymal cysts (EC). A number of methods have been proposed for their treatment – open surgical interventions, aspiration of cyst contents, sclerotherapy, epididymal cystectomy. In the literature, there are separate works in which attempts were made to study the use of sclerotherapy in the treatment of EC. However, the presented messages are single, there are no data of comparative studies of the use of various methods of treatment of this pathology. The aim of the study was to study the clinical efficacy of sclerotherapy in the treatment of epididymal cysts in terms of long-term indicators. Aim – to study the clinical efficacy of sclerotherapy in the treatment of EC in terms of long-term indicators. Materials and methods. 82 patients with EC aged 18 to 45 years were included in 2 groups: in the treatment of 47 patients in the comparison group, a standard approach was used, in the treatment of 36 patients in the main group, the method of EC sclerotherapy was used. EC sclerotherapy included anesthesia, aspiration of the cyst contents and injection of sclerosant, under ultrasound guidance, puncture of the epididymal cyst was performed, its contents were evacuated, then sclerosant (ethoxysclerol 1% – 2.5 ml) was injected into the cyst cavity with an exposure of 5 min. Results. It was found that during sclerotherapy in the treatment of EC in patients of the main group after the treatment, the dynamics of spermogram indices was more favorable than in the comparison group. In the long-term period (after 6-12 months), these patients had significantly higher levels of ejaculate volume and sperm count, the rate of movement of motile spermatozoa and the proportion of progressively motile spermatozoa than in the comparison group. The use of the sclerosing method increases the clinical efficacy of EC treatment, while the frequency of reproductive events (pregnancy in female partners of patients who underwent sclerotherapy) is 2.7 times higher than in the group where standard surgery was performed. Discussion. Over the past two decades, different authors have proposed different types of sclerosing substances. A number of studies are presented in the literature, the results of which have demonstrated the effectiveness of aspiration and sclerotherapy in the treatment of benign scrotal cysts. A sufficiently high efficiency of EC sclerotherapy was shown. We also found that the use of the sclerotherapy method increases the clinical effectiveness of EC treatment, while the frequency of reproductive events significantly increases. Conclusion. Sclerotherapy is an effective and safe treatment for obstructive azoospermia caused by EC.

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