Pancreatectomy and auto-islet transplant in patients with chronic pancreatitis

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…Indeed, in the first 135 cases of TP-IAT for CP at UMN, only 16% were attributed to alcohol, and 60% were idiopathic (Jie et al, 2005); in more recent cases (Sutherland et al, 2011b) fewer are classified as idiopathic and more as genetic in origin because of the identification of genes associated with CP as well as pancreatic cancer (Braganza et al, 2011). In the series at the University of Cincinnati, only 14% of the cases of CP were attributed to alcohol (Ahmad et al, 2005;Sutton et al, 2010).…”

“…The discovery of SPINK1 mutations in various types of CP, such as tropical calcific, alcoholic, and autoimmune pancreatitis, blurs the borders between the particular CP subtypes Other risk factors for CP include biliary lithiasis, anatomical variants like annular pancreas or divisum, hypertriglyceridemia, hypercalcemia, sphincter of Oddi dysfunction, and trauma (Ahmad et al, 2005;Braganza et al, 2011;Jie et al, 2005;Witt et al, 2011;). The key histopathologic features of CP, regardless of the etiology, are varying degrees (Kobayashi et al, 2010;Kobayashi et al, 2011) and combinations of pancreatic fibrosis, acinar atrophy, acute and chronic inflammation, and distorted or blocked ducts (Braganza et al, 2011).…”

“…If pain persists or recurs, then the next step is pancreatic resection. Because previous surgical drainage procedures (Puestow or Berger or Frey) compromise islet yield if a subsequent TP-IAT is done (Bellin et al, 2010a;Jie et al, 2005;Sutherland et al, 2011b), the current UMN paradigm is to do any indicated drainage procedures endoscopically only (Sutherland et al, 2011b). Then, if the endoscopic drainage is unsuccessful, the authors proceed to resection rather than surgical drainage.…”

“…The authors' experience indicates that TP with preservation of -cell mass by immediate isolation and intraportal transplantation of islets from the excised pancreas should be www.intechopen.com considered as a primary surgical option for patients who have painful CP refractory to less invasive procedures (Blondet et al, 2007;Jie et al, 2005;Sutherland et al, 2011b;Wahoff et.al., 1995a). The main criterion for success of the islet autograft per se is whether insulin independence is maintained or surgical diabetes made milder.…”

“…The outcomes in the UMN series have been periodically published (Farney et al, 1991;Farney et al, 1998;Gores et al, 1992;Gruessner et al, 2004;Hering et al, 2004;Jie et al, 2005;Morrow et al, 1984;Najarian et al, 1979;Najarian et al, 1980;Najarian et al, 1977;Robertson et al, 2001;Sutherland et al, 1978;Sutherland et al, 1980a;Sutherland et al, 2004a;Sutherland et al, 2009a;Sutherland et al, 2009b;Sutherland et al, 2011b;Wahoff et al, 1995a;Wahoff et al, 1995b), including in children Bellin et al, 2008;Bellin et al, 2010a;Bellin et al, 2010b;Bellin et al, 2011b;Wahoff et.al., 1996).…”