The Surgery of the Pancreas, as Based Upon Experiments and Clinical Researches

Senn, Nicholas

doi:10.1097/00000441-188610000-00009

Cited by 25 publications

(11 citation statements)

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“…Since the early descriptions of pancreatitis by Fitz 4 and Senn, 5 the role of surgical intervention in pancreatitis has been controversial. Surgical intervention for pancreatitis was often used to exclude other conditions, as in the 1917 report by Davis 6 of a presumed gallbladder empyema that was truly a pancreatic abscess.…”

Section: Discussionmentioning

confidence: 99%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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ObjectiveTo assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). Summary Background DataSurgical intervention has been the mainstay of treatment for infected peripancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. MethodsA retrospective chart review of 1993 to 1997 was performed on 82 patients at a tertiary care public teaching hospital who had computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess. Culture results, need for subsequent surgical intervention, length of stay, and death rate were assessed. ResultsOne hundred thirty-five aspirations were performed in 82 patients (57 male patients, 25 female patients) with a mean age of 40 years (range 17-68). The etiologies were alcohol (41), gallstones (32), and other (9). The mean number of Ranson's criteria was four (range 0 -9). All patients received antibiotics. Forty-eight patients had evidence of pancreatic necrosis on computed tomography scan. Cultures were negative in 40 patients and positive in 42. Twenty-five of the 42 culture-positive patients had PCD as primary therapy, and 6 required subsequent surgery. Eleven patients had primary surgical therapy, and five required subsequent surgery. Six patients were treated with only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. ConclusionsHistorically, patients with positive peripancreatic aspirate culture have required operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for culture-positive patients, with surgical intervention reserved for patients in whom treatment fails.Historically, the presence of an infected peripancreatic fluid collection or pancreatic abscess has mandated operation. Primary surgical treatment is successful for most patients, but the death rate is reportedly 15% to 80%, and surgery is associated with reoperation and prolonged lengths of stay.1 It has been more than 20 years since the treatment of pancreatic abscess was reviewed at our institution.2 In that report, Holden et al identified a death rate of 50% among 28 patients treated operatively and a complication rate of 93%.The availability of percutaneous catheter drainage (PCD) under radiologic guidance has replaced surgical drainage as the primary treatment of intraabdominal and hepatic abscesses. 3 A natural progression of the use of PCD has been its application for peripancreatic fluid collections and abscess. To ascertain the relative merits of PCD and to guide patient selection, we performed a retrospective chart review of patients with peripancreatic fluid collections or pancreatic abscess who had computed tomography (CT)-guided aspiration.

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Section: Discussionmentioning

confidence: 99%

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

et al. 2000

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“…Seit Nicolas Senn [1] 1886 erstmals die Auffassung vertrat, daû die chirurgische Entfernung der Nekrosen ein einleuchtendes Therapiekonzept bei der akuten Pankreatitis darstellt, ist das operative Management der akuten Pankreatitis ein Thema kontroverser Diskussionen geblieben. Die verfu È gbaren Literaturdaten sind ku È rzlich von Wyncoll [2] einer kritischen Analyse unterzogen worden.…”

Section: Discussionunclassified

Die Indikation zur Operation der akuten Pankreatitis – ein Streitthema

Foitzik¹

1999

Visc Med

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The frequently discussed question of whether and when patients with acute pancreatitis should be operated cannot be conclusively answered today. Studies from the last 10 years allow two conclusions: 1) Surgery should be postponed until necroses are clearly demarcated and the patients condition has stabilized; 2) complete necrosectomy and drainage of all pathways of necrosis should be achieved with the first intervention because morbidity increases with reoperations. These two aims may, however, not be achieved in critically ill patients in whom the indication for surgery remains controversial. The analysis of the current literature suggests that neither the bacteriological status nor the extent of (intra- and/ or extra-)pancreatic necroses per se are indications for surgery. The patients general condition is far more important, i. e. the systemic reaction of the organism to pancreatic injury. Besides a few absolute indications for surgery, it is currently generally agreed upon that surgery is indicated in the presence of extensive and/or infected pancreatic necrosis if the patients condition fails to stabilize despite intensive care therapy (including antibiotics). In patients with stable vital signs and organ functions surgery should be delayed beyond the 4th week of illness. After that time, surgery is indicated for extensive and/or infected necrosis because experience has shown that patients do usually not recover completely otherwise. An additional waiting period is justified in circumscribed or sterile necroses since these patients often recover completely without surgery. The main problem and still unanswered question is whether (and how long) patients in unstable general condition profit from further intensive care and at what point they are in risk due to further waiting. In these cases, it seems plausible to recommend documentation of the disease course by the APACHE II score over 2 to 3 days and to operate when the score increases.

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“…One of the first to recommend surgical intervention for pancreatitis was the Chicago surgeon Nicholas Senn[8] cited by Rocha et al[9]. At that time, in the 1880s, pancreatitis was believed to be the response of the pancreas to duodenal disease.…”

Section: Acute Pancreatitis In 20th Centurymentioning

confidence: 99%

Clinical pancreatology I: Pancreatic medical history

Andrén‐Sandberg¹

2010

NAJMS

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The present article and subsequent reviews will not be to report all what has been published, but rather to give an introduction samples that hopefully make the reader eager to read the whole article or articles with “a taste of clinical pancreatology in 2010”. The main sources of literatures were PubMed, and the additional Journals such as Pancreas, Pancreatology and Journal of the Pancreas were also scrutinized. Only some full articles in almost all languages were included in the review, other articles, however, that were too superficial or too poor in other ways, were omitted, and the publications of non-human study were excluded.

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The Surgery of the Pancreas, as Based Upon Experiments and Clinical Researches

Cited by 25 publications

References 0 publications

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

Does an Infected Peripancreatic Fluid Collection or Abscess Mandate Operation?

Die Indikation zur Operation der akuten Pankreatitis – ein Streitthema

Clinical pancreatology I: Pancreatic medical history

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