Duodenum-Preserving Resection of the Head of the Pancreas in Treatment of Chronic Pancreatitis: The Munich Experience

Wilker, D.; Schweiberer, L.; Knoefel, Wolfram Trudo; Izbicki, Jakob R.; Geißler, Klaus; Eibl-Eibesfeldt, B.

doi:10.1007/978-3-642-75319-0_65

Cited by 9 publications

(12 citation statements)

References 9 publications

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“…[48] showed in a large series with 258 patients that the incidence of postopera tive pancreatic fistula following duodenum-preserving pancreatic head resection is 3.1 %. The same fistulae rates are reported by Izbicki et al [45] and Shalimov and Lifshits [47], Bleeding occurred postoperatively in 1.9, 5,4.5 and 8% of the patients in the studies of Biichler et al [48], Izbicki et al [45], Klempa et al [46] and Wilker et al [49], respectively. The most common postoperative complica tion found by Biichler et al [48] following duodenum-preserving pancreatic head resection was cardiopulmonary dysfunction, occurring in 11.6% of the patients studied.…”

Section: Duodenum -Preserving Pancreatic Head Resectionsupporting

confidence: 69%

“…The operative mortality rate after duodenum-pre serving pancreatic head resection has been reported at between 0 and 4.5% in studies with various numbers of patients [45][46][47][48][49][50]. Total postoperative morbidity is be tween 16 and 50%, which is comparable to the Whipple procedures [45][46][47][48][49], Biichler ct al. [48] showed in a large series with 258 patients that the incidence of postopera tive pancreatic fistula following duodenum-preserving pancreatic head resection is 3.1 %.…”

Section: Duodenum -Preserving Pancreatic Head Resectionsupporting

confidence: 51%

“…The most common postoperative complica tion found by Biichler et al [48] following duodenum-preserving pancreatic head resection was cardiopulmonary dysfunction, occurring in 11.6% of the patients studied. [49], A tran sient delay in gastric emptying after a duodenum-preserv ing pancreatic head resection was reported only by Klem pa et al [46], in 9% of their patients. The incidence of this complication was the same as for patients who had had the classical Whipple resection, according to a prospective randomized trial comparing both surgical procedures [46].…”

Section: Duodenum -Preserving Pancreatic Head Resectionmentioning

confidence: 99%

See 2 more Smart Citations

Which Is the Better Operation in Chronic Pancreatitis: Pylorus-Preserving Whipple or Duodenum-Preserving Pancreatic Head Resection?

Friess¹,

Müller²,

Büchler³

1996

Dig Surg

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Surgical treatment in patients suffering from chronic pancreatitis is still discussed controversially. The classical Whipple resection which has been the standard operation in chronic pancreatitis for several decades is continuously replaced by organ-preserving surgical procedures. The pylorus-preserving Whipple resection, a modification of the classical Whipple, and the duodenum-preserving pancreatic head resection are two competitive operations in patients with chronic pancreatitis and pancreatic head-related complications. A randomized, controlled clinical trial comparing duodenum-preserving pancreatic head resection and pylorus-preserving Whipple resection shows that duodenum-preserving pancreatic head resection can be carried out in chronic pancreatitis with morbidity and mortality similar to that of the pylorus-preserving Whipple procedure. Furthermore, this study demonstrates the superiority of the duodenum-preserving pancreatic head resection with regard to postoperative quality of life and glucose metabolism, which are responsible for faster weight gain and convalescence. Delayed gastric emptying and biliary fistulae, which may lead to morbidity following pylorus-preserving Whipple, do not occur after duodenum-preserving pancreatic head resection. We conclude from these data that, in comparison with the pylorus-preserving Whipple resection, the duodenum-preserving pancreatic head resection provides better early postoperative outcome and convalescence as well as better preservation of the endocrine function, and should therefore be adopted as a new standard procedure in the treatment of pancreatic head complications in chronic pancreatitis.

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Section: Duodenum -Preserving Pancreatic Head Resectionsupporting

confidence: 69%

Section: Duodenum -Preserving Pancreatic Head Resectionsupporting

confidence: 51%

Section: Duodenum -Preserving Pancreatic Head Resectionmentioning

confidence: 99%

See 1 more Smart Citation

Which Is the Better Operation in Chronic Pancreatitis: Pylorus-Preserving Whipple or Duodenum-Preserving Pancreatic Head Resection?

Friess¹,

Müller²,

Büchler³

1996

Dig Surg

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“…The same problem to about the same extent occurs after the pylorus-preserving Whip ple operation [29][30][31]. In contrast, the incidence of dia betes mellitus is a minor problem following a duodenum preserving pancreatic head resection and appears in about 0-9% of the patients [ 15,32], As 40-60% of the pancreas is resected in the pylorus-preserving Whipple operation compared to 30-40% in the duodenum-preserving resec tion, one might conclude that improved glucose metabo lism following the latter procedure is simply related to the mass of the preserved pancreas. Since the exocrine func tion is decreased in the same manner in both groups, this does not see to be true.…”

Section: Discussionmentioning

confidence: 89%

Duodenum-Preserving Resection of the Head of the Pancreas: The Future

Friess¹,

Müller²,

Büchler³

1994

Dig Surg

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In a randomized unicenter clinical study duodenum-preserving pancreatic head resection and pylorus-preserving Whipple operation were prospectively compared in patients with chronic pancreatitis. Preoperatively, 10 days and 6 months postoperatively the patients were investigated with regard to glucose tolerance, pain relief, weight gain, hospital readmission, professional rehabilitation and postoperative complications. In the 6 months’ follow-up, patients who underwent the duodenum-preserving pancreatic head resection had less pain, greater weight gain, a better glucose tolerance and a higher insulin secretion capacity than patients with the pylorus-preserving Whipple resection. The postoperative mortality was zero and the postoperative morbidity was comparable in both groups (duodenum-preserving pancreatic head resection: 3/20 patients (15%), pylorus-preserving Whipple operation 4/20 patients (20%)). Duodenum-preserving pancreatic head resection provides a better postoperative outcome than the pylorus-preserving Whipple resection. Therefore, it should be considered as a new standard operation in patients with chronic pancreatitis and pancreatic head-related complications.

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“…In cases of distal common bile duct stenosis or duodenal obstruction, extensive decompression of the bile duct and the duodenum represents an adequate management of these organ complications [38,45,69]. Identification of the intrapancreatic course of the distal bile duct may be facilitated by insertion of a metal probe into the common bile duct through a proximal choledochotomy [70].…”

Section: Control Of Complicationsmentioning

confidence: 99%