Changes in pancreatic resection for chronic pancreatitis over 28 years in a single institution

Falconi, Massimo; Valerio, Adriano; Caldiron, E.; Salvia, Roberto; Sartori, Nora; Talamini, Giorgio; Bassi, Claudio; Pederzoli, Paolo

doi:10.1046/j.1365-2168.2000.01391.x

Cited by 21 publications

(8 citation statements)

References 27 publications

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“…Pancreatic fistula after surgery for chronic pancreatitis is reported to vary from 3 to 8.3% [43, 44, 45, 46]. The incidence of pancreatic fistula following surgery for chronic pancreatitis in a series from Hamburg was 8 (5.2%) of 154 patients and 4 (11%) of 36 patients with extrahepatic portal hypertension compared to 4 (3%) of 118 patients without extrahepatic portal hypertension [47].…”

Section: Complicating Acute and Chronic Pancreatitismentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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Section: Complicating Acute and Chronic Pancreatitismentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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“…PPPD has also been demonstrated to be associated with a normal gastrointestinal hormonal milieu and a better weight gain postoperatively, and it has become a common procedure not only for benign but also for malignant disorders of the periampullary region . Moreover, the current data support the performance of PPPD in the surgical treatment of cancer of the pancreatic head .…”

Section: Introductionmentioning

confidence: 57%

“…In the second stage, the second portion of the duodenum and the head of the pancreas, with the distal common bile duct, were PPPD has also been demonstrated to be associated with a normal gastrointestinal hormonal milieu and a better weight gain postoperatively, and it has become a common procedure not only for benign but also for malignant disorders of the periampullary region. [7][8][9][10][11][12][13][14][15][16][17] Moreover, the current data support the performance of PPPD in the surgical treatment of cancer of the pancreatic head. 18 -21 In this article, we review the impact of PPPD on pancreatic surgery, so as to elucidate the surgical procedure of choice for patients with cancer of the pancreatic head.…”

Section: Introductionmentioning

confidence: 59%

The impact of pylorus-preserving pancreatoduodenectomy on surgical treatment for cancer of the pancreatic head

Ogata

Hishinuma

2002

Journal of Hepato-Biliary-Pancreatic Surgery

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Pylorus-preserving pancreatoduodenectomy (PPPD) was reintroduced in 1978. This pylorus-preserving modification was designed to minimize complications related to gastric resection, such as early satiety, marginal ulceration, and bile reflux gastritis, as well as diarrhea and dumping. Since 1978, PPPD has been performed preferentially for benign and malignant diseases of the periampullary region and pancreatic head. Some groups have argued against PPPD for cancer of the pancreatic head, because the pylorus-preserving procedure is likely to compromise the field of resection and does not allow lymph node dissection of the peripyloric and perigastric groups. However, comparative survival rates after PPPD have been the same as, or better than, those with classic pancreatoduodenectomy, showing the rationale for PPPD as a radical resection procedure for cancer of the pancreatic head. PPPD can be performed with low mortality. Delayed gastric emptying, which is the most common complication in the immediate postoperative period after PPPD, is always transient. Many investigators have shown that body weight and the majority of nutritional parameters are better than after PD. PPPD does not appear to cause any negative outcomes. We conclude that PPPD is the surgical procedure of choice for cancer of the head of the pancreas.

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“…However, groove pancreatitis is likely more common than generally reported; in fact, in one large single-center study based on institution experience, it represented 70 % of the indications for PD in chronic pancreatitis patients [4,8,10]. Surgical removal of the affected ''groove area'' is a reliable way of relieving the pain and duodenal obstructive symptoms associated with this condition.…”

Section: Discussionmentioning

confidence: 92%

“…Jaundice is rare (see Table 1). Alcohol consumption appears to be the greatest risk factor due to increased viscosity of the pancreatic juices leading to increased back pressure through a disrupted minor pancreatic duct secondary to duodenal wall myoadenomatosis and fibrosis [3][4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%