Glucose Homeostasis and Endocrine Pancreatic Function in Patients with Chronic Pancreatitis Before and After Surgical Therapy

Bittner, R.; Butters, M.; Büchler, Markus; Nagele, Sibylle; Roscher, R.; Beger, H. G.

doi:10.1097/00006676-199401000-00007

Cited by 62 publications

(30 citation statements)

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“…Moreover, with regard to development of endocrine and exocrine pancreatic insufficiency a definitive advantage can be shown for the "extended" drainage operation as well as for the Beger procedure (47,48,51,66,67,74) as compared to Whipple (68,71) or Longmire-Traverso (47,72,73,75). Preservation of the gastroduodenal passage and of the continuity of the common bile duct seem to be of utmost importance for regulation of the exocrine secretory capacity and glucose metabolism (68,76). Results of a prospective randomized trial comparing Frey with Longmire-Traverso at the authors' institution confirmed these findings (69).…”

Section: Results Of Surgery In Chronic Pancreatitismentioning

confidence: 99%

Customized Surgical Strategy in Chronic Pancreatitis

Mann

Izbicki

2005

Scand J Surg

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Despite major advances in the management of patients with chronic pancreatitis, yet the disease remains an enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment. In most of the cases intractable pain is the main indication for surgical intervention. Furthermore complications related to adjacent organs, endoscopically not permanently controlled pancreatic pseudocysts, ductal pathology, conservatively intractable internal pancreatic fistula or suspected malignancy also require surgery. The ideal surgical approach should address all these problems -tailoring the various therapeutic options to meet the individual patient's needs. In our opinion, the ideal procedure for chronic pancreatitis is the duodenum preserving pancreatic head resection in terms of an extended drainage procedure, were the extent of the pancreatic head resection may be tailored to the morphology of the pancreatic gland, thus allowing a tailored concept (to resect and/or drain as much as necessary but as little as possible). Looking at the present data, there is no need to transsect the pancreatic axis above the portal vein. If portal vein thrombosis is present, an extended drainage procedure is mandatory without transsection of the neck of the pancreas.

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Section: Results Of Surgery In Chronic Pancreatitismentioning

confidence: 99%

Customized Surgical Strategy in Chronic Pancreatitis

Mann

Izbicki

2005

Scand J Surg

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“…The mentioned rate of patients with an enlargement of the pancreatic head associated with complications of the surrounding structures indicates that a drainage procedure alone cannot deal with the variety of morphological alterations in the majority of patients. According to this, the principle of the duodenum-preserving pancreatic head resection is the local resection of the enlarged pancreatic head and the preservation of the physiological gastrointestinal pathway [30]. In spite of the fact that 44 patients (resection) had pseudocysts >5 cm, an additional treatment like pseudocyst-jejunostomy was necessary in only 3 patients.…”

Section: Discussionmentioning

confidence: 99%

Pseudocyst Treatment in Chronic Pancreatitis – Surgical Treatment of the Underlying Disease Increases the Long-Term Success

Schultze-Seemann

Siech

Beger³

2005

Dig Surg

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Background: For reasons of persisting controversies concerning indications for surgery, we evaluated chronic pancreatitis patients following pancreatic head resection or drainage procedure for pseudocysts located in the pancreatic head. Material and Methods: 206 patients (166 male, 40 female) with chronic pancreatitis and pseudocysts in the pancreatic head were operated between April 1982 and July 2001. 169 patients (82%) were treated with the duodenum-preserving pancreatic head resection, a pseudocyst-jejunostomy was performed in 37 patients (18%). Results: The hospital mortality was 0.4%. The late mortality was 19% in a median follow-up of 7.3 years. The rate of patients with complete relief of pain was significantly higher after resection compared to drainage procedure in the long-term follow-up (94 vs. 75%; p = 0.003). With regard to recurrence of pseudocysts, patients had an elevated rate of reoperations following drainage procedure (13 vs. 1%; p = 0.008). The endocrine function was significantly better preserved in patients of the drainage group compared to the resection group (no diabetes 67 vs. 35%, p < 0.01). Conclusion: The resection has, compared to drainage procedures alone, the advantage of low recurrence rate of pseudocysts and a high rate of pain-free patients in the long-term follow-up. However, the risk of diabetes is increased in the resection group.

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“…Hinsichtlich der Spätergebnisse fanden sich in den Berichten von Warren [46,47], Guillemin [48,49], Leger [50,51] [34][35][36][37][38][39][40]43]. Alle diese Aspekte führen zur Favorisierung dieses Operationsverfahrens [38].…”

Section: Ergebnisse Der Duodenum Erhaltenden Pankreaskopfresektionunclassified

Organ erhaltende Operationsverfahren bei chronischer Pankreatitis – die Duodenum erhaltende Pankreaskopfresektion

Tempia-Caliera¹,

Fischer²,

Hennig³

et al. 2001

Visc Med

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Organ-Preserving Surgical Techniques in Patients with Chronic Pancreatitis – Duodenum-Preserving Pancreatic Head Resection Chronic pancreatitis is a benign inflammatory process of the pancreas that leads to permanent damage of the gland and loss of functional parenchyma. The evolution of the disease is progressive and associated with development of exocrine and endocrine pancreatic insufficiency, with a higher risk of developing pancreatic cancer. Alcohol abuse is the most frequent etiology for chronic pancreatitis in Western industrialized countries. The predominant symptom of chronic pancreatitis is pain, and it is often difficult to control pain sufficiently with analgesics. Other symptoms are diabetes mellitus, steatorrhea and weight loss. The diagnosis of chronic pancreatitis is usually made on a medical history, but retrograde endoscopic pancreaticography (ERCP) and an abdominal contrastenhanced CT scan are still the gold standards for diagnosis and staging. However, the conventional MRI combined with MR angiography and MR cholangio-pancreaticography is a very challenging alternative. Indications for surgery are severe abdominal pain with pancreatic head enlargement, common bile duct stenosis, intestinal obstruction, compression of retropancreatic vessels or suspicion of malignancy. The duodenum-preserving pancreatic head resection (DPPHR) is an organ-preserving operation, which was developed to replace the Whipple procedures in patients with chronic pancreaitis. It eliminates chronic pancreatitis-related complications and leads to pain relief. In this procedure, the pancreatic head is resected subtotally, and the body and tail of the pancreas, the stomach, the duodenum, and the extrahepatic bile duct are preserved. In an own series of 298 patients, hospital mortality was 1% and the most frequent perioperative complication was bleeding in 5.7% of the patients. Pancreatic fistulas occurred in 2.7% of the patients, and the total reoperation rate was 5.7%. After an average follow-up of 5.7 years, 91% of the patients with DPPHR were free of pain or with minimal signs of disease. 63% of the patients were professionally active. Late mortality was 12.6%. DPPHR in chronic pancreatitis is a safe and effective operation procedure providing long-term pain relief in treating chronic pancreatitis-related complications. Therefore, this organ-preserving procedure should be considered as first procedure to treat chronic pancreatitis-related complications.

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Glucose Homeostasis and Endocrine Pancreatic Function in Patients with Chronic Pancreatitis Before and After Surgical Therapy

Cited by 62 publications

References 0 publications

Customized Surgical Strategy in Chronic Pancreatitis

Customized Surgical Strategy in Chronic Pancreatitis

Pseudocyst Treatment in Chronic Pancreatitis – Surgical Treatment of the Underlying Disease Increases the Long-Term Success

Organ erhaltende Operationsverfahren bei chronischer Pankreatitis – die Duodenum erhaltende Pankreaskopfresektion

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