Which Surgeries Are the Best Choice for Chronic Pancreatitis: A Network Meta-Analysis of Randomized Controlled Trials

Mou, Yu; Song, Yi; Chen, Hongyu; Wang, Xing; Huang, Wei; Liu, Xu-Bao; Ke, Nengwen

doi:10.3389/fsurg.2021.798867

Cited by 8 publications

(6 citation statements)

References 55 publications

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“…Számos tanulmány vizsgálta és hasonlította össze a különböző műtéteket, és abban egyetértés volt, hogy valamennyi beavatkozás egyformán eredményesen a panaszok enyhítésében a krónikus pancreatitisnek pancreasfeji megnagyobbodással járó formájában, de elismerték, hogy a DMPFR-k előnyösebbek a korai posztoperatív kimenetel tekintetében [8,9,11,12,17,[28][29][30]. Ez különösen a berni módosításra igaz a rövidebb időtartama miatt [14,19,31]. Ugyanakkor a késői eredményeket tekintve az adatok nem egyöntetűek [10,[19][20][21].…”

Section: Megbeszélésunclassified

Krónikus pancreatitis miatt végzett pancreasfej-resectiós műtéteink elemzése

Kelemen,

Deák,

Ferencz

et al. 2023

MaSeb

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BevezetésA krónikus pancreatitisnek gyulladásos pancreasfej-megnagyobbodással járó formájában a sebészi kezelésre többféle beavatkozás is kínálkozik, úgymint a Beger-, Frey-, Whipple-műtét és a berni módosítás. Jelen tanulmány az ezekkel elért eredményeket hasonlítja össze, továbbá a pancreatojejunalis és biliodigesztív anastomosis terén végzett innovációkat is ismerteti.Anyag és módszerek1991 és 2021 között összesen 231 pancreasfej resectiót végeztünk. Az adatokat retrospektíven elemeztük. Kérdőívek útján vizsgáltuk a késői eredményeket is. Eredmények: A statisztikai feldolgozás alapján a berni módosítás és a Frey-műtét előnyösebbnek bizonyult a Whipple- és a Beger-műtétnél az operáció időtartama és a transzfúziós igény (P < 0,001) tekintetében, míg az intenzív osztályos és teljes posztoperatív ápolási idő (P < 0,001) terén a Whipple-műtéthez viszonyítva voltak kedvezőbbek. A korai morbiditás gyakorisága a Whipple-műtétet követően volt a legnagyobb (P = 0,004). Ezek a különbségek szignifikánsak voltak. A reoperáció és a mortalitás aránya hasonló volt a csoportokban. A betegek életminősége elfogadható volt, annak ellenére, hogy az esetek zömében az alkohol és nikotin abúzus megmaradt.KövetkeztetésA Frey-műtét és a berni módosítás volt a legkedvezőbb a korai posztoperatív kimenetel szempontjából, technikailag egyszerűbb volta miatt viszont inkább az utóbbi beavatkozást részesítjük előnyben. Mindkét műtét során a pancreatojejunalis anastomosis készítésére egyrétegű tovafutó varratot, és epepangás esetén annak megoldására egy extrapancreaticusan végzett biliodigesztív összeköttetés létesítését ajánljuk a kedvező tapasztalatok alapján.

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Section: Megbeszélésunclassified

Krónikus pancreatitis miatt végzett pancreasfej-resectiós műtéteink elemzése

Kelemen,

Deák,

Ferencz

et al. 2023

MaSeb

View full text Add to dashboard Cite

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“…edema, in ammation, necrosis, and brosis) that lead to a negative impact on the quality of life [1,2]. It is an uncommon disease with a reported annual incidence of 4-14 cases per 100,000 individuals worldwide [3]. Epidemiological knowledge of CP in Latin America and particularly in Colombia remains scarce [4].…”

Section: Introductionmentioning

confidence: 99%

“…Frey's procedure is a duodenum preserving head resection combined with lateral pancreaticojejunostomy. This technique has reasonable pain control at long-term follow-up and is associated with a better quality of life, shorter operation time, and lower rate of postoperative complications than other surgical procedures in CP [1,3,15]. However, studies in Latin America and Colombia are scarce and fail to characterize its effectiveness and short/long-term post-operative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Frey's procedure for chronic pancreatitis: A 8-year single-center experience in Colombia

González

Ayala

Caballero

et al. 2022

Preprint

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Background Chronic pancreatitis is an inflammatory disease characterized by irreversible morphological changes due to chronic pancreatic fibrosis. The treatment goals are to relieve pain, preserve function, and prevent further pathological consequences. Endoscopic treatment, surgery, or both are options for untreatable pain or suspected malignancy. Frey procedure is a reasonable surgical intervention because of its hybrid character, combining resection and drainage. Unfortunately, there is limited information about the outcomes of this procedure in Latin America, and few cases described in Colombia. This study aims to describe the experience of Colombia's population undergoing Frey's surgery for chronic pancreatitis in a high complexity center experience treating this disease. Methods A retrospective review of a prospectively collected database of patients who underwent a Frey procedure due to chronic pancreatitis between January 2014 to February 2022 in a high complexity center in Bogotá, Colombia, was made. A demographic, clinical and postoperative outcome description was performed. Logistic regression and t-test analysis was performed when appropriate between operative variables and long-term outcomes. Results Eighteen patients met the inclusion criteria. 55.5 % of patients were male. Chronic pancreatitis etiology in most cases (83.3% n=15) was idiopathic. The mean duration of symptoms and chronic pancreatitis diagnosis before surgery was 18.6 ± 26.9 months. Overall morbidity was 38.88%. One patient died at 30 days of follow-up. The median follow-up time was 42.5 (IQR 19;65 months). The mean pain reduction was 3.3 ± 1.02 points according to the visual analog score. Six patients were diagnosed with malignant conditions after surgery (mean 27.8 ± 7.5 months). A protective exposure is present in patients with duct diameter < 6 mm. (OR 0.6 CI 95% 0-0.9).ConclusionAccording to our data, Frey's procedure remains safe and feasible, with acceptable outcomes in terms of pain relief and pancreatic function. The study confirms the importance of a longstanding follow-up due to an inherent risk of pancreatic malignancy. Our data suggest that pancreatic duct size < 6 mm at the moment of the procedure was related to a lesser risk of pancreatic cancer; however, further prospective studies with a larger sample size would be helpful to confirm these results.

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“…edema, inflammation, necrosis, and fibrosis) that lead to a negative impact on the quality of life [ 1 , 2 ]. It is an uncommon disease with a reported annual incidence of 4–14 cases per 100,000 individuals worldwide [ 3 ]. Epidemiological knowledge of CP in Latin America and particularly in Colombia remains scarce [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Frey’s procedure is a duodenum preserving head resection combined with lateral pancreaticojejunostomy. This technique has reasonable pain control at long-term follow-up and is associated with a better quality of life, shorter operation time, and lower rate of postoperative complications than other surgical procedures in CP [ 1 , 3 , 16 ]. However, studies in Latin America and Colombia are scarce and fail to characterize its effectiveness and short/long-term post-operative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Frey’s procedure for chronic pancreatitis: a 8-year single-center experience in Colombia

et al. 2022

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Background Chronic pancreatitis is an inflammatory disease characterized by irreversible morphological changes due to chronic pancreatic fibrosis. The treatment goals are to relieve pain, preserve function, and prevent further pathological consequences. Endoscopic treatment, surgery, or both are options for untreatable pain or suspected malignancy. Frey procedure is a reasonable surgical intervention because of its hybrid character, combining resection and drainage. Unfortunately, there is limited information about the outcomes of this procedure in Latin America, and few cases described in Colombia. This study aims to describe the experience of a pancreatic surgery reference center in the management of patients undergoing Frey’s surgery for chronic pancreatitis. Methods A retrospective review of a prospectively collected database of patients who underwent a Frey procedure due to chronic pancreatitis between January 2014 to February 2022 in a hospital in Bogotá, Colombia, was made. A demographic, clinical, and postoperative outcome description was performed. Mann–Whitney Willcoxon test was performed between operative variables and long-term outcomes. Results Eighteen patients met the inclusion criteria. 55.5% of patients were male. Chronic pancreatitis etiology in most cases (83.3% n = 15) was idiopathic. The median duration of symptoms and chronic pancreatitis diagnosis before surgery was 6.15 months (IQR 5;97). Overall morbidity was 38.88%. One patient died at 30 days of follow-up. The median follow-up time was 42.5 (IQR 19;65 months). The median pain reduction was 3 points according to the visual analog score. Six patients were diagnosed with malignant conditions after surgery (mean 27.8 ± 7.5 months). Wirsung’s duct size was statistically related with malignancy presentation after Frey’s procedure (Z = 2.54; P = 0.01). Conclusion According to our data, Frey’s procedure remains safe and feasible, with acceptable outcomes in terms of pain relief and pancreatic function. The study confirms the importance of a longstanding follow-up due to an inherent risk of pancreatic malignancy. Our data suggest that pancreatic duct size could be related with the malignancy diagnosis after Frey’s procedure; however, further prospective studies with a larger sample size would be helpful to confirm these results.

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Which Surgeries Are the Best Choice for Chronic Pancreatitis: A Network Meta-Analysis of Randomized Controlled Trials

Cited by 8 publications

References 55 publications

Krónikus pancreatitis miatt végzett pancreasfej-resectiós műtéteink elemzése

Krónikus pancreatitis miatt végzett pancreasfej-resectiós műtéteink elemzése

Outcomes after Frey's procedure for chronic pancreatitis: A 8-year single-center experience in Colombia

Outcomes after Frey’s procedure for chronic pancreatitis: a 8-year single-center experience in Colombia

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