Surgical Treatment Strategies in Chronic Pancreatitis

Yin, Zi; Sun, Jian; Yin, Dong; Wang, Jie

doi:10.1001/archsurg.2012.2005

Cited by 52 publications

(35 citation statements)

References 38 publications

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“…There is a range of surgical options, including resection, decompression and a combination of these (150), as well as TPIAT as reviewed by Bellin et al (15). Among drainage procedures, patients with a dilated main duct and without an inflammatory mass in the head of the pancreas are best managed with decompression of the duct (longtitudinal pancreatico-jejunostomy) and with either coring of the head (Frey procedure) or resection of the head (Beger procedure) (150).…”

Section: Resultsmentioning

confidence: 99%

“…Among drainage procedures, patients with a dilated main duct and without an inflammatory mass in the head of the pancreas are best managed with decompression of the duct (longtitudinal pancreatico-jejunostomy) and with either coring of the head (Frey procedure) or resection of the head (Beger procedure) (150). Patients with an inflammatory mass in the head of the pancreas, especially if malignancy cannot be excluded, will require pancreatic head resection (Whipple’s procedure), with or without pancreatic duct decompression.…”

Section: Resultsmentioning

confidence: 99%

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Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

et al. 2016

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Description Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Methods Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Results Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. Management: There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Conclusions Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

et al. 2016

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“…However, the pooled analysis indicated a significantly low incidence of postoperative morbidity in the DPPHR group, which was consistent with previous studies. [33] …”

Section: Discussionmentioning

confidence: 99%

Surgical strategies in the treatment of chronic pancreatitis

et al. 2017

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Background:Chronic pancreatitis (CP) is a common and frequently occurring disease. Pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. The Beger and Frey procedures are 2 main duodenum-preserving techniques in duodenum-preserving pancreatic head resection (DPPHR) strategies. We conducted this systematic review and meta-analysis to compare the clinical efficacy of DPPHR versus PD, the Beger procedure versus PD, the Frey procedure versus PD, and the Beger procedure versus the Frey procedure in the treatment of pancreatitis. The optimal surgical option for chronic pancreatitis is still under debate. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of different surgical strategies for chronic pancreatitis.Methods:Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched with the limitations of human subjects and randomized controlled trials (RCTs) text. Data were extracted by 2 of the coauthors independently and analyzed using the RevMan statistical software, version 5.3. Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias.Results:Seven studies involving a total of 385 patients who underwent the surgical treatments were assessed. The methodological quality of the trials ranged from low to moderate and included PD (n = 134) and DPPHR (n = 251 [Beger procedure = 100; Frey procedure = 109; Beger or Frey procedure = 42]). There were no significant differences between DPPHR and PD in post-operation mortality (RR = 2.89, 95% CI = 0.31–26.87, P = 0.36), pain relief (RR = 1.09, 95% CI = 0.94–1.25, P = 0.26), exocrine insufficiency (follow-up time > 60 months: RR = 0.91, 95% CI = 0.72–1.15, P = 0.41), and endocrine insufficiency (RR = 0.75, 95% CI = 0.52–1.08, P = 0.12). Concerning the follow-up time < 60 months, the DPPHR group had better results of exocrine insufficiency (RR = 0.22, 95% CI = 0.08–0.62, P = 0.04). However, operation time (P < 0.0001), blood transfusion (P = 0.02), hospital stay (P = 0.0002), postoperation morbidity (P = 0.0007), weight gain (P < 0.00001), quality of life (P = 0.01), and occupational rehabilitation (P = 0.007) were significantly better for patients who underwent the DPPHR procedure compared with the PD procedure. The comparison results of the Frey procedure and PD showed that both procedures had an equal effect in the pain relief, postoperation mortality, exocrine and endocrine function, and quality of life (QoL) (P > 0.05), whereas patients who underwent the Frey procedure had significantly reduced operative times (P < 0.05) and less blood transfusions (P < 0.05). Comparing the Beger procedure to the PD procedure, there were no significant differences in hospital stay, blood transfusion, postoperation morbidity or mortality, pain ...

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“…The problem is that there is neither an exact or validated measure of pain control nor randomised clinical studies comparing surgery with conservative treatment to help establish the indication of surgery [10]. It is usually recommended to consider surgery when the patient needs major opioids for more than 3 months and in case of treatment side efects or lack of obvious beneit [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Surgical Indications and Techniques to Treat the Pain in Chronic Pancreatitis

Serrablo¹,

Martín²,

Serrablo³

et al. 2017

Challenges in Pancreatic Pathology

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Chronic pancreatitis (CP) is a progressive inlammatory process, of the pancreatic gland and leads to damage and decrease in glandular tissue. Clinically, the pain is the most outstanding and incapacitating sign (95% of patients), as well as exocrine pancreatic insuiciency. The two main objectives in CP treatment are pain relief and complication management. Pain is the main surgical treatment indication. Patients with pancreatic duct dilation require surgical drainage, which provides an important pain relief (70-80%). Decompression (drainage), resection and neuroablation are the most commonly used surgical treatment options of CP. Derivative surgical procedures as Puestow-Gillesby or its modiication, Partington-Rochelle, are the best options if the Wirsung duct is dilated, and Izbiki procedure if it is not. Resection is the choice when there is an important afectation of the head of pancreas with repercussion in bile duct or duodenum, as well as those patients with suspicion of carcinoma or in those ones who cannot be ruled a malignant tumour. The resection surgical procedures are Whipple, Traverso-Longmire, Frey (resective-derivative) and Beger (resective-derivative). To conclude, surgeon must know not only every surgical procedure indications but also be familiarised with all of them. The surgical procedure must be individualised to the patient and the disease stage.

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Surgical Treatment Strategies in Chronic Pancreatitis

Cited by 52 publications

References 38 publications

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

Surgical strategies in the treatment of chronic pancreatitis

Surgical Indications and Techniques to Treat the Pain in Chronic Pancreatitis

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