Chronic pancreatitis: modern surgical management

Bachmann, Kai; Izbicki, Jakob R.; Yekebas, Emre F.

doi:10.1007/s00423-010-0732-0

Cited by 34 publications

(16 citation statements)

References 80 publications

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“…TDS and NPS patients were grouped together here since there was no major resection of pancreatic parenchymal involved in those patients. Sphincteroplasty has been shown to lead to colonization of the duct by bacteria from the colon, and therefore may play a role in fibrosis (28), which was not observed in our study. Secondly, it appears that resection of different regions of the pancreas determine islet yield as well.…”

Section: Discussioncontrasting

confidence: 64%

Prior Surgery Determines Islet Yield and Insulin Requirement in Patients With Chronic Pancreatitis

et al. 2013

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Background Total pancreatectomy with islet autotransplantation (TP-IAT) is safe and effective in the management of intractable pain associated with chronic pancreatitis (CP). Prevention of pancreatogenic diabetes after TP-IAT is related to islet yield from the diseased pancreas. The purpose of this study is to compare islet yield and insulin requirement in the 76 patients who underwent different surgical procedures prior to TP-IAT at the Medical University of South Carolina between the years 2009 to 2011. Methods Patients were grouped into four categories based on the operation they had before TP-IAT: transduodenal sphincteroplasty or no prior surgery (TDS/NPS, n=50), Whipple or Beger procedure (WB, n=14), distal pancreatectomy (DP, n=8) or lateral pancreaticojejunostomy (LPJ, n=4). Islets were harvested from pancreases of those patients at our cGMP facility. Total unpurified islets were transplanted into patients via portal vein infusion. Pancreatic fibrosis, islet yield, cell viability and insulin requirement were measured. Results The pancreases of TDS/NPS and WB patients were less fibrotic, and had higher islet yield compared to those who had DP or LPJ. Higher islet yield also correlated with a greater diabetes free rate and a lesser insulin requirement at the following intervals: pre-operative, post-operative and 6 months after TP-IAT. Conclusions Prior surgery is strongly correlated with the extent of pancreatic fibrosis, islet yield and insulin requirements in CP patients undergoing TP-IAT. The history of prior pancreatic resection and drainage procedures may be used to predict post-operative islet function and help to determine the optimal timing for TP-IAT in CP patients.

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Section: Discussioncontrasting

confidence: 64%

Prior Surgery Determines Islet Yield and Insulin Requirement in Patients With Chronic Pancreatitis

et al. 2013

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“…Surgical intervention is kept as an option of last resort when other treatments have failed and the severity of disease has increased substantially and pain becomes unmanageable[22]. As an alternative to the current conservative step-up practice, there is a new suggestion emerging that surgery early in the clinical course of CP is beneficial in terms of pain control and pancreatic function.…”

Section: Discussionmentioning

confidence: 99%

Role of original and modified Frey's procedures in chronic pancreatitis

Tan¹,

Zhang²,

Li³

et al. 2016

WJG

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AIMTo retrospectively review patients with chronic pancreatitis (CP) treated with Frey’s procedures between January 2009 and January 2014.METHODSA retrospective review was performed of patients with CP treated with Frey’s procedures between January 2009 and January 2014 in the Department of Pancreatic Surgery. A cross-sectional study of postoperative pain relief, quality of life (QoL), and alcohol and nicotine abuse was performed by clinical interview, letters and telephone interview in January 2016. QoL of patients was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) version 3.0. The patients were requested to fill in the questionnaires by themselves via correspondence or clinical interview.RESULTSA total of 80 patients were enrolled for analysis, including 44 who underwent the original Frey’s procedure and 36 who underwent a modified Frey’s procedure. The mean age was 46 years in the original group and 48 years in the modified group. Thirty-five male patients (80%) were in the original group and 33 (92%) in the modified group. There were no differences in the operating time, blood loss, and postoperative morbidity and mortality between the two groups. The mean follow-up was 50.3 mo in the original group and 48.7 mo in the modified group. There were no differences in endocrine and exocrine function preservation between the two groups. The original Frey’s procedure resulted in significantly better pain relief, as shown by 5-year follow-up (P = 0.032), better emotional status (P = 0.047) and fewer fatigue symptoms (P = 0.028). When stratifying these patients by the M-ANNHEIM severity index, no impact was found on pain relief after the two types of surgery.CONCLUSIONThe original Frey’s procedure is as safe as the modified procedure, but the former yields better pain relief. The severity of CP does not affect postoperative pain relief.

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“…Patients included in the study underwent either a drainage procedure (pancreaticojejunostomy), a duodenum‐preserving pancreatic head resection (Beger or Frey procedure), a pancreaticoduodenectomy or a left‐sided pancreatic resection (tail resection). The indication for the type of surgery was based on the location of pathological changes in the pancreas on preoperative computed tomography or MRI.…”

Section: Methodsmentioning

confidence: 99%