The role of pancreatojejunostomy in patients without dilated pancreatic ducts

Delcore, Romano; Rodríguez, Francisco J.; Thomas, James H.; Forster, Jameson; Hermreck, Arlo S.

doi:10.1016/s0002-9610(05)80129-1

Cited by 69 publications

(33 citation statements)

References 20 publications

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“…Surgical drainage seems to be the first treatment required in patients with main pancreatic duct dilated to preserve pancreatic function [262]. Delcore proposed drainage operation in small-duct disease [263], but no benefit was proven [264]. The rationale of drainage operation is the hypothesis that high pressure in the duct system and the surrounding pancreatic parenchyma cause dilation of the pancreatic duct and pain [265,266].…”

Section: S7mentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

165

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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Section: S7mentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

165

112

View full text Add to dashboard Cite

show abstract

“…A reduction of tissue pressure in patients undergoing drainage procedure was followed by a substantial relief of pain [23]. Nevertheless, in patients without markedly dilated ducts, pain cannot be well explained by increased duct or tissue pressure [24]. The overwhelming majority of patients in our series with pseudocysts in the pancreatic head suffered from severe pain.…”

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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“…Patients with pain but non-dilated PDs are not considered candidates for drainage procedures by most pancreatic surgeons. Several studies have shown that ductal decompression in patients with non-dilated PD (<5 mm) is associated with inadequate relief of pain [78,79,80]. …”

Section: Surgical Therapymentioning

confidence: 99%

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

et al. 2013

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Chronic pancreatitis is an inflammatory disease of the pancreas with abdominal pain as the most prominent symptom. Adequate treatment of patients with chronic pancreatitis remains a major challenge, mainly because of the lack of evidence-based treatment protocols. The primary goal of treatment is to achieve long-term pain relief, control of the complications associated with the disease, and to restore the quality of life. Currently, a conservative step-up approach is often used for the treatment of pain; progression to severe and intractable pain is considered necessary before invasive treatment is considered. Recent studies, however, suggest that surgical intervention should not be considered only as last-resort treatment, since it can mitigate disease progression, achieve excellent pain control, and preserve pancreatic function. In this review, we present a state-of-the art overview of endoscopic and surgical treatment options for patients with painful chronic pancreatitis, and elaborate on the timing of surgery.

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The role of pancreatojejunostomy in patients without dilated pancreatic ducts

Cited by 69 publications

References 20 publications

Italian consensus guidelines for chronic pancreatitis

Italian consensus guidelines for chronic pancreatitis

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

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

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