Chronic pancreatitis surgery: Difference between revisions
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*The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage. | *The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage. | ||
*Laparoscopic LPJ is the minimally invasive procedure with the success rate being directly proportional to the duct size.<ref name="pmid15156382">{{cite journal |vauthors=Tantia O, Jindal MK, Khanna S, Sen B |title=Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases |journal=Surg Endosc |volume=18 |issue=7 |pages=1054–7 |year=2004 |pmid=15156382 |doi=10.1007/s00464-003-9210-x |url=}}</ref><ref name="pmid21584825">{{cite journal |vauthors=Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA |title=Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy |journal=J. Gastrointest. Surg. |volume=15 |issue=7 |pages=1243 |year=2011 |pmid=21584825 |doi=10.1007/s11605-011-1495-9 |url=}}</ref> | *Laparoscopic LPJ is the minimally invasive procedure with the success rate being directly proportional to the duct size.<ref name="pmid15156382">{{cite journal |vauthors=Tantia O, Jindal MK, Khanna S, Sen B |title=Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases |journal=Surg Endosc |volume=18 |issue=7 |pages=1054–7 |year=2004 |pmid=15156382 |doi=10.1007/s00464-003-9210-x |url=}}</ref><ref name="pmid21584825">{{cite journal |vauthors=Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA |title=Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy |journal=J. Gastrointest. Surg. |volume=15 |issue=7 |pages=1243 |year=2011 |pmid=21584825 |doi=10.1007/s11605-011-1495-9 |url=}}</ref> | ||
*Complications such as intraoperative hemorrhage, postoperative hemorrhage and anastomotic leak | |||
==== 1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection ==== | ==== 1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection ==== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.[1]
Surgery
| Chronic pancreatitis causing intractable abdominal pain | |||||||||||||||||||||||||||||||||||||||||
| Dilated pancreatic duct (>6-7mm) | Non dilated pancreatic duct (<6-7mm) | ||||||||||||||||||||||||||||||||||||||||
| Fibrosis in the head of pancreas Poor drainage | Head-dominant disease | Tail-dominant disease | Diffuse parenchymal involvement | ||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||
| Lateral pancreaticojejunostomy (Puestow procedure) | Lateral pancreaticojejunostomy with localized pancreatic head resection (Frey procedure) | Classic pancreaticoduodenectomy OR pylorus-preserving pancreaticoduodenectomy OR Duodenum-preserving pancreatic head resection (Beger procedure) | Distal pancreatectomy | Total pancreatectomy with islet autotransplantation | |||||||||||||||||||||||||||||||||||||
Surgery for the pain management:
- Surgery is usually considered when pain management fails with medical and endoscopic therapies.[2][3][4]
- The goals of surgery are:
- Effective pain relief
- To reduce morbidity
- To preserve long-term pancreatic function
1. Dilated pancreatic duct:
- Obstructive pancreatopathy is the underlying pathology in patients with dilated pancreatic duct.
- Patients are usually managed with drainage procedure that may or may not be accompanied with limited resection.
1.1 Lateral pancreaticojejunostomy (LPJ):
- LPJ is the conventional surgical approach for pancreatic drainage.[5][6]
- The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage.
- Laparoscopic LPJ is the minimally invasive procedure with the success rate being directly proportional to the duct size.[7][8]
- Complications such as intraoperative hemorrhage, postoperative hemorrhage and anastomotic leak
1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection
2. Nondilated pancreatic duct:
2.1 Head-dominant disease
2.1.1 Pancreaticoduodenectomy
2.1.2 Duodenal-preserving pancreatic head resection
2.2 Tail-dominant disease
2.3 Diffuse parenchymal disease
Surgery for the management of complications:
1. Duodenal stenosis
2. Terminal biliary stenosis
3. Pancreatic pseudocysts
4. Gastric varices due to splenic vein occlusion
5. Fibrosing stenosis of the transverse colon
References
- ↑ Society for Surgery of the Alimentary Tract (SSAT) (2004). "Operative treatment for chronic pancreatitis". Retrieved 2007-06-09.
- ↑ Ammann RW, Muellhaupt B (1999). "The natural history of pain in alcoholic chronic pancreatitis". Gastroenterology. 116 (5): 1132–40. PMID 10220505.
- ↑ Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984). "Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients". Gastroenterology. 86 (5 Pt 1): 820–8. PMID 6706066.
- ↑ Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP (1994). "The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis". Gastroenterology. 107 (5): 1481–7. PMID 7926511.
- ↑ PUESTOW CB, GILLESBY WJ (1958). "Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis". AMA Arch Surg. 76 (6): 898–907. PMID 13532132.
- ↑ Nealon WH, Matin S (2001). "Analysis of surgical success in preventing recurrent acute exacerbations in chronic pancreatitis". Ann. Surg. 233 (6): 793–800. PMC 1421322. PMID 11371738.
- ↑ Tantia O, Jindal MK, Khanna S, Sen B (2004). "Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases". Surg Endosc. 18 (7): 1054–7. doi:10.1007/s00464-003-9210-x. PMID 15156382.
- ↑ Eid GM, Entabi F, Watson AR, Zuckerbraun BS, Wilson MA (2011). "Robotic-assisted laparoscopic side-to-side lateral pancreaticojejunostomy". J. Gastrointest. Surg. 15 (7): 1243. doi:10.1007/s11605-011-1495-9. PMID 21584825.