Combined Pancreatic Duct and Upper Gastrointestinal and Biliary Tract Drainage in Chronic Pancreatitis

Prinz, Richard A.; Aranha, Gerard V.; Greenlee, H.

doi:10.1001/archsurg.1985.01390270099017

Cited by 43 publications

(39 citation statements)

References 12 publications

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“…On the other hand drainage procedures failed to provide complete pain relief in up to 60% of patients [14][15][16]. Fur thermore pancreatitis-associated complications of adja cent organs such a distal common bile duct obstruction and duodenal stenosis required additional bypass proce dures [17,18], and carcinoma cannot definitively be ruled out [19]. While partial pancreatoduodenectomy provides complete pain relief in up to 80% of patients [20], the pro cedure is assumed to be burdened with higher morbidity and mortality rates, although in major pancreatic centers early morbidity and mortality rates are comparable to draining procedures [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Techniques of Duodenum-Preserving Resection of the Head of the Pancreas in Chronic Pancreatitis

et al. 1994

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Two techniques of duodenum-preserving resections of the head of the pancreas have been described by Beger and Frey for treatment of chronic pancreatitis. These techniques were compared in a prospective randomized trial following a pilot study. The course of 31 patients with chronic pancreatitis was prospectively documented with 25 patients having undergone Beger’s and 6 Frey’s procedure. Thereafter 38 patients were randomly allocated to either Beger’s or Frey’s group. The mean interval between symptoms and surgery was 5.4 years in the pilot study and 5.6 years in the randomized study. 17 adjacent organs (13 common bile duct stenoses, 4 duodenal stenoses) were affected in 13 patients in the pilot study, and 35 adjacent organs (28 common bile duct stenoses, 6 duodenal stenoses, 1 pancreatopleural fistula) in 28 patients in the randomized study. The mean follow-up was 4.8 years in the pilot study and 1.5 years in the randomized study (minimum 6 months). In both series there was no mortality. Morbidity was 26% in the pilot study (28% Beger, 17% Frey) and 16% in the randomized study (21 % Beger, 11 % Frey). In the pilot study complete pain relief was achieved in 92 and 83% of patients after Beger’s and Frey’s procedure, and in the randomized trial in 95 and 89% of patients after Beger’s and Frey’s procedure. Associated affection of adjacent organs was definitively resolved in 94% (16 of 17) in the pilot study (92% Beger, 100% Frey) and in 94% (33 of 35) in the randomized study (90% Beger, 100% Frey). Both techniques of duodenum-preserving pancreatic head resection are equally safe and effective with regard to pain relief and definitive control of complications affecting adjacent organs.

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Section: Discussionmentioning

confidence: 99%

Comparison of Two Techniques of Duodenum-Preserving Resection of the Head of the Pancreas in Chronic Pancreatitis

et al. 1994

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“…A prospective surgical series reported on an incidence of duodenal obstruction (transient or permanent) of 12% [66]. Surgery is indicated for patients with failure to resolve the obstruction within 1-2 weeks of conservative therapy as this suggests the presence of an irreversible duodenal obstruction.…”

Section: Common Bile Duct Stenosis and Duodenal Obstructionmentioning

confidence: 99%

Chronic pancreatitis: modern surgical management

Bachmann

Izbicki

Yekebas

2010

Langenbecks Arch Surg

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Introduction Chronic pancreatitis (CP) is a disease with enormous social and personal impact. It is most commonly caused by the abuse of alcohol combined with nicotine. CP is usually characterised by an inflammatory mass located in the pancreatic head. Its natural course is characterised by persistent or recurrent painful attacks as well as progressive loss of pancreatic function due to fibrosis of the parenchyma with consecutive endocrine and exocrine insufficiency. Conclusions The only success parameter of any treatment is the effective long-lasting pain relief and improvement in the quality of life. The surgical armamentarium includes simple drainage procedures, resections of different extents or a combination of both. Duodenum-preserving resection of the pancreas offers the best short-term outcome according to trials conducted so far. It has the benefit of combining the highest safety with the highest efficiency. Additionally, the extent of the operation can be adapted to the morphology of the individual patient.

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“…Strategies for salvage in patients with persistent or recurrent pain after drainage procedures include redoing or extending the pancreatojejunostomy and resection procedures [79] . Of patients undergoing pancreatic duct drainage procedures, 25%-66% require concomitant biliary or gastric drainage, because of functionally significant obstruction of the bile duct or duodenum [80,81] . Biliary or duodenal strictures have been reported to be more likely in patients with large-duct disease than in their counterparts without dilated ducts [81] .…”

Section: Decompression/drainage Operationsmentioning

confidence: 99%