Tratamento cirúrgico da pancreatite crônica com a técnica de F rey: panorama atual

Abstract

-Introduction -Chronic pancreatitis is a progressive inflammatory disorder characterized by irreversible destruction of pancreatic parenchyma and may be associated with disabling chronic pain and permanent loss of endocrine and exocrine function. Main indication for surgery is intractable abdominal pain and choosing the best technique to be used for a patient remains a challenge. The technique described by Frey combines the effectiveness of pain control characteristic of resection surgery with low mortality and morbidity of derivative procedures. Aim -To compare and discuss the results of surgical treatment of chronic pancreatitis with Frey procedure. Methods -A literature review of scientific articles available in Medline/Pubmed database and the national theses descriptors with terms chronic pancreatitis, surgical treatment and Frey procedure. It was selected the most important articles and that reported more experience with this surgical option. Conclusions -Frey procedure proves to be an option with high effectiveness in controlling abdominal pain secondary to chronic pancreatitis in the long term in patients with abdominal pain and enlarged pancreatic head, with lower rates of morbidity and mortality. The studies showed little interference of technique in the deterioration of endocrine and exocrine pancreatic functions. ABCDDV/817RESUMO -Introdução -A pancreatite crônica é desordem inflamatória progressiva caracterizada pela destruição irreversível do parênquima pancreático, podendo estar associada à dor crônica incapacitante e perda permanente da função endócrina e exócrina. A principal indicação cirúrgica é a dor abdominal intratável e a escolha da melhor técnica a ser empregada permanece um desafio. A técnica descrita por Frey conseguiu combinar a eficácia no controle da dor das operações de ressecção com as baixas taxas de mortalidade e morbidade das derivativas. Objetivo -Comparar e discutir os resultados do tratamento cirúrgico da pancreatite crônica com a técnica de Frey. Métodos -Revisão bibliográfica de 276 artigos científicos disponíveis no Medline/ Pubmed e no banco de dados de teses nacionais com os descritores pancreatite crônica, tratamento cirúrgico e cirurgia de Frey. Foram selecionados os 30 artigos de maior importância e que relataram maior experiência com esta opção cirúrgica. Conclusões -A técnica de Frey demonstra ser opção de alta efetividade no controle da dor abdominal secundária à pancreatite crônica no longo prazo naqueles pacientes com dor abdominal incapacitante e aumento volumétrico da cabeça pancreática, com menores taxas de morbidade e mortalidade. Os estudos demonstraram pequena interferência da técnica na deterioração das funções endócrina e exócrina.

Natural History and Endoscopic Management of Pancreaticopleural Fistula: A Tertiary Care Center Experience

“…Cross-sectional imaging (CECT/MRCP) identifies PPF in approximately 70 to 80% of cases. 4,13,[16][17][18] Initial treatment includes conservative measures, that is, nil per oral, parenteral nutrition, thoracocentesis, and octreotide infusion (used to decrease pancreatic fistula output and closing time. [19][20][21] Even though conservative treatment can resolve the condition in 20 to 50% of cases, prolonged treatment time, infection risk, and long duration hospitalization are limiting factors.…”

“…After documentation of pleural effusion on chest radiography, thoracocentesis is performed, and elevated levels of amylase (> 2000 IU/mL) in the pleural fluid are considered diagnostic of PPF. 4 14 15 16 PPF usually results in left-sided pleural effusion; however, right-sided and bilateral effusions can occur in 19 and 14% of patients, respectively. In our study, 80% patients had left-sided pleural effusion.…”

“…Cross-sectional imaging (CECT/MRCP) identifies PPF in approximately 70 to 80% of cases. 4 13 16 17 18…”

Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study

“…This may be due to disturbances of excretion such as hepatocellular injury (drug or viral hepatitis, pregnancy or sepsis) or abnormalities of the flow between the hepatocyte and the ampulla of Vater, such as gallstones of the main bile duct, periampullary neoplasm or pancreatitis. 4,7,8 The clinical sign of jaundice has a broad spectrum of etiologies and can range in severity from asymptomatic cases that do not require intervention, to others in which there may even be an imminent risk of death. 4 Individuals with jaundice but without infectious signs may experience weight loss or itching.…”