Optimizing Surgical Therapy for Chronic Pancreatitis

Knoefel, Wolfram Trudo; Eisenberger, Claus Ferdinand; Strate, Tim; Izbicki, Jakob R.

doi:10.1159/000065085

Cited by 16 publications

(7 citation statements)

References 62 publications

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“…This illustrates the importance of halting the inflammatory process usually located in the pancreatic head to preserve endocrine and exocrine pancreatic function. The only suitable indication for a simple drainage procedure and for longitudinal pancreaticojejunostomy is in patients with a dilatated ductal diameter (>7 mm), or 'chain of lakes', without an inflammatory mass in the pancreatic head [48,89]. It can be performed with low mortality and morbidity (approximately 3% and 20%, respectively).…”

Section: Major Procedures For Management Of Pain In Chronic Pancreatitismentioning

confidence: 99%

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Chronic pancreatitis: modern surgical management

Bachmann

Izbicki

Yekebas

2010

Langenbecks Arch Surg

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Introduction Chronic pancreatitis (CP) is a disease with enormous social and personal impact. It is most commonly caused by the abuse of alcohol combined with nicotine. CP is usually characterised by an inflammatory mass located in the pancreatic head. Its natural course is characterised by persistent or recurrent painful attacks as well as progressive loss of pancreatic function due to fibrosis of the parenchyma with consecutive endocrine and exocrine insufficiency. Conclusions The only success parameter of any treatment is the effective long-lasting pain relief and improvement in the quality of life. The surgical armamentarium includes simple drainage procedures, resections of different extents or a combination of both. Duodenum-preserving resection of the pancreas offers the best short-term outcome according to trials conducted so far. It has the benefit of combining the highest safety with the highest efficiency. Additionally, the extent of the operation can be adapted to the morphology of the individual patient.

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Section: Major Procedures For Management Of Pain In Chronic Pancreatitismentioning

confidence: 99%

“…Therefore, despite this lack of clear evidence, one may hypothesise that the probable disadvantage of draining procedure is that a concomitant inflammatory pseudotumour in the pancreatic head including strictures and chronic pseudocysts is not addressed [48,58,65].…”

Section: Major Procedures For Management Of Pain In Chronic Pancreatitismentioning

confidence: 99%

Chronic pancreatitis: modern surgical management

Bachmann

Izbicki

Yekebas

2010

Langenbecks Arch Surg

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“…Осложнения, требующие инвазивного вмешательства, возникают примерно у 30-60% пациентов [21]. Как правило, хирургическое или эндоскопическое вмешательство назначается сразу при подозрении на злокачественность или при наличии резистентной к консервативному лечению боли, например при наличии конкрементов ПЖ.…”

Section: лечениеunclassified

Surgical treatment of chronic pancreatitis: the state of the art

Kemper

Izbicki

Bachmann

2019

Bul. of the Club of Pancr.

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Chronic pancreatitis is a common disease accompanied with considerable morbidity and mortality. Complications associated with chronic pancreatitis, such as pseudocysts, stenosis of adjacent anatomic structures or pain that cannot be managed conservatively, may be treatable surgically or interventionally by endoscopy. Surgery is superior to endoscopy in regard to long-term pain management. Modern duodenum preserving pancreatic resections using the Berger, Frey, or Hamburg techniques possess a number of substantial drawbacks. Duodenum preserving pancreatic resection is the surgical procedure of choice in patients with inflamed changes of the head of the pancreas. Despite great progress in recent years regarding the management of complications, postoperative morbidity is high. The best timing of surgery, the ideal standardized perioperative management are the focus of current research. The minimally invasive approach offers numerous benefits in comparison with open surgery, but these procedures can only be performed at highly specialized centers with very highly qualified surgeons.

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“…Not uncommonly, CP results in inability to work and early retirement. Overall, adequate treatment of CP and its long‐term complications remains a major challenge [2, 3].…”

Section: Introductionmentioning

confidence: 99%

For which type of chronic pancreatitis is the “Hamburg procedure” indicated?

Kutup

Vashist

Kaifi

et al. 2009

J Hepato Biliary Pancreat

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Background A pancreatic duct diameter (PDD) ranging from 4 to 5 mm is regarded as ''normal''. The ''large duct'' form of chronic pancreatitis (CP) with a PDD [ 7 mm is considered a classical indication for drainage procedures. In contrast, in patients with so-called ''small duct pancreatitis'' (SDP) with a PDD \ 3 mm, extended resectional procedures are suggested including, as an ''ultima ratio'', even total pancreatectomy. Methods Between 1992 and 2008, among a total of 978 patients who were treated for CP, 51 suffered from SDP and underwent longitudinal ''V-shaped excision'' of the anterior aspect of the pancreas. The interval between symptoms and surgery varied from 12 to 123 months. Median follow-up was 87 months (range 32-131 months). A pain score was used as well as a multidimensional psychometric quality-of-life questionnaire. Results Hospital mortality was 0%. The perioperative morbidity (30 days) was 19.1%. Median pain score decreased by 95.5%. Global quality of life index increased in median by 53.6% (range 37.5-80%). In 35 patients (75%), complete pain relief was achieved. The impairment of exocrine and endocrine pancreatic function after surgery was statistically not significant. Conclusions Longitudinal ''V-shaped excision'' of the ventral pancreas is a secure and effective approach for SDP, achieving significant improvement in quality of life and pain relief. While sparing patients from unnecessary, extended resectional procedures, it appears not to result in substantial deterioration of exocrine and endocrine pancreatic function.

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Optimizing Surgical Therapy for Chronic Pancreatitis

Cited by 16 publications

References 62 publications

Chronic pancreatitis: modern surgical management

Chronic pancreatitis: modern surgical management

Surgical treatment of chronic pancreatitis: the state of the art

For which type of chronic pancreatitis is the “Hamburg procedure” indicated?

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