From Tutoring Gross Anatomy to Pancreatic Surgery Innovation

The training for pancreatic surgery still is not conducted according to standardized protocols, and academic programs differ between countries and hospitals. Moreover, due to recent technological innovations such as minimally invasive and robotic surgery, and the broader indications for complex pancreatic procedures due to the use of neoadjuvant chemotherapy, training is continuously redefining itself. The historical paradigm of “see one, do one, teach one” has been challenged and might have become obsolete. Finally, the rising number of surgical residents along with the limited time required practicing during residency might represent a major limitation to becoming an independent surgeon. Gross anatomy is a solid practice for the active learning of human anatomy during medical school. With regards to the pancreas, it offers a unique opportunity to both actively study the pancreatic gland anatomy during dissection and simulate actual surgical procedures. A critical review of the literature was conducted, aiming to assess the role of gross anatomy in surgical training and possible future perspectives.

Effect of kumis on the secretion of the pancreatic gland

Kumis is a drink that energetically affects the activity of the gastrointestinal tract. A number of authors (Zarnitsyn, Grigorieva, Udintsev, Kandrashkin, Zorin, etc.) have established many details in the influence of kumis on the secretory function of the stomach.

Perspectives of lymphotropic antibioticotherapy in acute pancreatitis

Objective. To study up the possibilities of improvement of the treatment results in patients, suffering an acute pancreatitis, using the method of delivery of antibiotic to pancreatic gland. Materials and methods. The authors have proposed and conducted the experimental investigation on 20 male rats, consisting of the manners to deliver of ceftriaxone towards pancreatic gland. Results. Taking into account the enhances antibacterial efficacy of pancreatic gland homogenate, than while antibiotic delivery using other methods, there appear that lymphotropic therapy owes a targeted character and must be considered a perspective one. Conclusion. To three groups of laboratory animals ceftriaxone was prescribed intramuscularly, intraperitoneally and in accordance to lymphotropic method. To the control group of laboratory animals, the fourth one, antibiotic, was not applied. The zone growth retardation for E. Coli, while application of lymphotropic method, comparing with intramuscular and intraperitoneal methods of the preparation delivery, was enhanced.

Estimation of variants of the pancreatic gland pathology in patients, suffering complicated forms of chronic pancreatitis in late postoperative period

Objective. Estimation of variants of the pancreatic gland pathology and rate of the unfavorable results occurrence in late postoperative period in patients, suffering complicated forms of chronic pancreatitis, depending on the procedures of surgical treatment. Materials and methods. Results of surgical treatment of complicated forms of chronic pancreatitis in department of the gut surgery in 2007 - 2017 yrs were studied in 107 patients, who were divided into two groups: the Group I – 67 (62.7%) patients, in whom pancreato- and virsungodigestive operations were performed, and the Group II – 40 (37.4%) patients, in whom duodenum—preserving resection-drainage surgical interventions were done. Results. Unfavorable variants of pancreatic pathology were observed significantly more frequently in patients of the Group I – in 34/67 (50.7%) in comparison with patients of the Group II – in 6/40 (15.0%) (χ2=9.49, p=0.002). Conclusion. Analysis of rate of the unfavorable results occurrence in late postoperative period, depending on surgical tactics appled, have shown a trustworthy advantage of the resection-drainage operations.

Early postoperative outcomes of dunking pancreatojejunostomy

Background: There is no gold standard method for pancreatico-enteric reconstruction. In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice. In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out 75 (6.6%) developed Grade ‘B’ POPF and three out 75 (3.3%) developed Grade ‘C’ POPF. 20 out 75 (26.6%) had grade ‘A’ DGE, five out of 75(6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (invagination) pancreatojejunostomy has acceptable early outcomes with clinically significant/relevant postoperative pancreatic fistula, delayed gastric emptying and post pancreatectomy haemorrhage rates of 10.4% (grade B and C), 33.2% and 5.3% respectively. The outcomes are comparable with those of Duct-to-Mucosa PJ mentioned in literature.