Perioperative and follow-up results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis

Müller, Michael; Friess, Helmut; Leitzbach, Sarah; Michalski, Christoph; Berberat, Pascal O.; Ceyhan, Güralp O.; Hinz, Ulf; Ho, Choon-Kiat; Köninger, Jörg; Kleeff, Jörg; Büchler, Markus W.

doi:10.1016/j.amjsurg.2007.08.065

Cited by 46 publications

(29 citation statements)

References 30 publications

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“…In this series, there was one conversion to an open procedure and 78% of patients experienced a POPF, with clinically significant pancreatic fistula occurring in 22%. This coincides with the rates published for open CP (median =21.2%), where most often only clinically significant fistulas were noted (1,7,9,10,(25)(26)(27)37). There were no cases of EI or endocrine dysfunction, and Clavien grade III or higher complications occurred in one patient (11%) with no reoperations or mortality.…”

Section: Outcomes Of Mis Cpsupporting

confidence: 76%

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

2016

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Recent improvements in imaging techniques and more frequent use of cross-sectional imaging have led to an increase in the identification of benign and low-grade lesions of the pancreas. Patients with resectable cancers are commonly treated by either a Whipple procedure or distal pancreatectomy (DP) based on the location of the tumor. Central pancreatectomy (CP) is a less commonly performed operation that has recently been utilized for resection of these now more frequently diagnosed low-grade and benign lesions located in the mid pancreas. Lesions that may have a relatively more indolent nature include branchtype intraductal papillary mucinous neoplasm (IPMNs), mucinous cystic neoplasms, neuroendocrine tumors, and solid pseudopapillary tumors. The goal of a CP is complete extirpation of the lesion, while preserving pancreatic parenchyma to reduce the risks of developing diabetes and exocrine insufficiency (EI). Although open CP has been shown to be safe and efficacious, the outcomes of a minimally invasive approach are still relatively underreported and therefore unknown. In this paper, we describe our surgical approach to performing a CP with an accompanying video demonstration of the key portions of the operation. multiple anastomoses required for restoring continuity of the hepatic duct, pancreatic duct and intestinal tract (1,10). The concerns surrounding CP include high incidence of post-operative pancreatic fistula (POPF) and potentially inadequate oncologic resection in cases of malignancy (9). However, studies have shown that although the rates of POPF after CP are relatively high (20-50%), oftentimes these patients possess soft glands and small ducts, which are both well-established risk factors for POPF (9). Also, in most cases the POPF is clinically insignificant [International Study Group on Pancreatic Fistula (ISGPF) grade A] (9). Therefore, CP is a reasonable approach for centrally located, benign or low-grade pancreatic lesions that allows preservation of pancreas parenchyma and adjacent organs.With increasing utilization of laparoscopic and robotic pancreatectomy, patients can now undergo either an open or minimally invasive surgery (MIS) procedure. Laparoscopic and robotic PD has gained interest due to comparable morbidity, mortality and oncologic outcomes versus open PD when performed in select patients (11-15). For DP, MIS approach has now become the standard of care due to its favorable outcomes in comparison to open DP (11,16). In a recent meta-analysis comparing 1,814 patients undergoing open versus laparoscopic DP, the laparoscopic approach resulted in less blood loss, shorter hospital length of stay (LOS), fewer surgical site infections and lower morbidity (17). Similarly, a MIS approach for CP has become increasingly common with the goal of decreasing the impact of morbidity related to the decreased size of incisions, shorter hospital stays, and shorter time until return to work. While both laparoscopic and robotic CP are being performed, laparoscopy may be somewhat limited giv...

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Section: Outcomes Of Mis Cpsupporting

confidence: 76%

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

2016

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“…Köninger et al [17] recently published a study that compared the Beger procedure with its Berne variant (Büchler procedure), and showed that the Büchler procedure is easier to perform (as indicated by a shorter operating time), while it improves the quality of life in the same way as the classical Beger procedure. Müller et al [18] were further able to show that the Büchler procedure is a surgically safe intervention reaching similar results with regard to the quality of life.…”

Section: Surgical Treatment Of Cpmentioning

confidence: 72%

Indications for Endoscopic or Surgical Treatment of Chronic Pancreatitis

Rieder

Michalski²,

Friess³

2010

Dig Dis

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In patients suffering from chronic pancreatitis, pain as the predominant symptom remains a therapeutic challenge which often cannot be tackled conservatively. Since pancreatic duct obstruction – frequently within the pancreatic head – is an important etiological factor, treatment in these cases aims at decompressing the duct either endoscopically or surgically. Endoscopic drainage includes sphincterotomy, dilation of strictures, removal of stones, and insertion of a stent; it has a success rate of 30–100%. Surgical treatment may be accomplished by drainage or resection procedures. Drainage procedures (such as the longitudinal opening of the pancreatic duct followed by a pancreaticojejunostomy) can be performed with a low rate of postoperative complications (6–30%) and mortality (0–2%), and can achieve long-term pain relief in 65–85% of the cases. Furthermore, there are a variety of resection procedures such as pancreaticoduodenenectomy (Whipple procedure), pylorus-preserving pancreaticoduodenenectomy, different types of the duodenum-preserving pancreatic head resection (i.e. Beger, Frey, or Büchler procedures), segmentectomy, and V-shaped excision of the pancreatic duct. However, the surgical procedure of choice is controversially discussed. While it has been shown that parenchyma-preserving surgery is superior to more extensive resections, it remains unclear which of the modifications of the parenchyma-sparing procedures is suited best for which case. Recently, two randomized controlled trials have demonstrated that surgical treatment is superior to endotherapy in long-term pain reduction, physical health score results, and the number of reinterventions. Thus, in patients with chronic pancreatitis refractory to conservative medical treatment, surgery rather than endotherapy is the standard of care. Parenchyma-preserving resections should preferably be performed because they ensure lower morbidity and mortality, preserve endocrine function, and improve quality of life.

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“…Normal function of pancreatic remnants. Outflow of the distal stump through the anastomosed jejunum is shown, as is preferential outflow of the proximal stump through the duodenum carried out in the procedure proposed by authors at the University of Bern (Berne Technique) [14,15].…”

Section: Discussionmentioning

confidence: 99%

Roux-en-Y end-to-end and end-to-side double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy

Chirletti¹,

Peparini²,

Caronna³

et al. 2009

Langenbecks Arch Surg

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Perioperative and follow-up results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis

Cited by 46 publications

References 30 publications

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

Indications for Endoscopic or Surgical Treatment of Chronic Pancreatitis

Roux-en-Y end-to-end and end-to-side double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy

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