Beger s operation and the Berne modification: origin and current results
|
|
- Adele Carr
- 5 years ago
- Views:
Transcription
1 J Hepatobiliary Pancreat Sci (21) 17: DOI 1.17/s TOPICS Chronic pancreatitis: current treatment strategies Beger s operation and the Berne modification: origin and current results André L. Mihaljevic Jörg Kleeff Helmut Friess Received: 1 August 29 / Accepted: 12 August 29 / Published online: 2 October 29 Ó Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 29 Abstract Background/purpose The purpose of this paper is to illuminate the origin and current results of the duodenumpreserving pancreatic head resection () developed by Beger in the 197s, as well as its simplified Berne modification, for patients suffering from chronic pancreatitis (CP). Indications for the procedures and their results are presented on the basis of available data. Methods A selected review was made of the available data on the developed by Beger and its modifications. Results The organ-sparing developed by Beger, and its modifications, provide better pain relief, better preservation of exocrine and endocrine pancreatic function, and a superior quality of life compared with the more radical pancreaticoduodenectomy (PD, with or without pylorus-preservation), once the standard treatment for patients with CP. Recently published data on the long-term follow-up of studies comparing PD to indicate that the initial benefits of over PD might be less pronounced in the long-run. Conclusions The organ-preserving developed by Beger, and its modifications, have become established and well-evaluated surgical treatment options for patients with CP. Keywords Chronic pancreatitis Surgical treatment Resection Operation Partial pancreaticoduodenectomy Duodenum-preserving pancreatic head resection Beger s operation Berne modification A. L. Mihaljevic J. Kleeff H. Friess (&) Department of Surgery, Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, Munich, Germany helmut.friess@chir.med.tu-muenchen.de Introduction Chronic pancreatitis (CP) is a benign inflammatory disease of the pancreas that leads to irreversible damage of functional parenchyma and disruption of exocrine and endocrine function, ultimately resulting in gland atrophy with or without calcifications [1 3]. The incidence and prevalence of CP seems to be country-specific, with higher rates having been reported in Japan (incidence, 14.4 per 1, inhabitants; prevalence, 35.5 per 1, in 22) [4] than in European countries [5 7]. Interestingly, in Japan, incidence and prevalence rates have shown a marked increase over time [8]. Although the pathogenesis of CP is not yet fully understood, etiologic factors for CP have been wellestablished and are commonly summarized using the TI- GAR-O classification [9]: toxic-metabolic (e.g. alcohol), idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis or obstructive (e.g. pancreas divisum or pancreatic neoplasm). In industrialized countries, overconsumption of alcohol is the leading cause of CP, accounting for 65 9% of all cases [4, 6, 7]. Clinical presentation and indications for surgery The predominant clinical symptom in patients with CP is pain, which affects more than 9% of patients [1]. Other common symptoms are diabetes mellitus and steatorrhea, due to endocrine and exocrine insufficiency of the gland, respectively [1]. While the latter symptoms can be treated medically, intractable pain is the leading indication for surgery in patients with CP, with 5% of patients suffering from pain after 15 years despite medical treatment [1 12]. Although pain in patients with CP and pancreatic duct
2 736 J Hepatobiliary Pancreat Sci (21) 17: stenosis can be treated by endoscopic procedures, which offer success in approximately 65% of patients [13], two randomized prospective studies have shown the superiority of surgery over endotherapy [14, 15]. Other indications that warrant surgery in CP arise from local complications. CP is most frequently localized in the pancreatic head, and an inflammatory pseudotumor may lead to the compression of neighboring organs, causing symptomatic duodenal and common bile duct obstruction, as well as vascular obstruction of the portal, superior mesenteric, and splenic veins. All of these may warrant surgery, especially if more than one complication is present at once. Pancreatic pseudocysts may be another indication for surgery, although endoscopic drainage procedures are effective in this situation as well. Finally, suspicion of a pancreatic malignancy warrants surgery, since CP is an independent risk factor for the development of pancreatic cancer [16 18]. Surgical treatment options for CP Two types of surgical interventions have been proposed and carried out in patients with CP: drainage and resection procedures. Mere drainage operations, most commonly the Partington Rochelle procedure, [19] in which a lateral pancreaticojejunostomy is constructed with a Roux-Y jejunal loop, have been successfully used to treat pain in patients with dilated pancreatic duct CP (large-duct CP) [2 22]. Although there is no universally accepted definition of large-duct CP, most authors classify large-duct CP as that having a pancreatic duct diameter of more than 6 7 mm [23 25]. The presence of a dilated pancreatic duct, however, is not the only prerequisite for a drainage operation, the other being the absence of local obstructive symptoms (such as common bile duct or duodenal obstruction), which are not addressed by drainage operations. Therefore, only about 25% of all CP patients qualify for a drainage operation in the first place [26]. Furthermore, while drainage operations are efficient and safe procedures, conferring shortterm pain relief in approximately 8% of patients [2, 22, 27], series with long-term follow up have yielded disappointing results, with approximately 4% of patients complaining of pain 2 years after surgery [21, 28, 29], most likely due to a progression of the chronic inflammation in the remaining pancreatic tissue. This seems understandable, given that pain in CP seems to be a multifactorial event involving neuro-immunological interactions [3 33], inflammation, and increased intraductal/intraparenchymal pressure [34] and thus may not be effectively treated by mere drainage of the pancreatic duct system. Many of the drawbacks of the drainage operation are addressed by resection procedures. Resection procedures remove the inflammatory mass in the pancreatic head found in approximately half of all CP patients and believed to be the pacemaker of CP [35, 36], thereby alleviating local compression symptoms, as well as achieving pain relief. Furthermore, resection procedures can be used in smallduct CP [23 25] and relieve common bile duct stenosis, which is present in 4 5% of patients [36]. The classical resection procedures for the pancreatic head are the Kausch Whipple pancreaticoduodenectomy (PD) [37, 38] and its pylorus-preserving counterpart described by Traverso and Longmire (pppd) [39]. PD has served as the primary surgical procedure for the treatment of CP since its introduction, as it is associated with long-term pain relief in a majority of patients and can be carried out with low mortality rates, especially at high-volume centers [4 43]. However, PD is associated with poor long-term results in patients with CP, and postoperative and overall morbidity remains high [4, 44 47]. Introduction of the pylorus-preserving PD (pppd) yielded mixed results as to the benefits it might bring in comparison to the classic PD [48 51]. A recent metaanalysis of 7 randomized controlled trials (RCT) including a total of 496 patients found no difference between the two procedures concerning in-hospital mortality, overall survival, and overall morbidity [52]. These studies, however, were carried out in patients suffering from pancreatic cancer, and no RCT exist comparing PD with pppd in patients with CP. However, Jimenez et al. report a retrospective trial (level IIb evidence) of 72 patients undergoing PD or pppd for CP, showing comparable rates of long-term pain relief, nutritional status, diabetes mellitus, and enzyme supplementation [42]. Pancreaticoduodenectomy (PD) with or without pylorus-preservation has remained the standard treatment option at many centers across the United States [53], may be due to unaccounted differences between CP patients in different countries [54]. Both procedures, however, were originally developed to treat malignant diseases of the pancreatic head and the periampullary region, whereas CP is a benign disorder of the pancreas that does not necessarily warrant radical surgical approaches. Beger s duodenum-preserving pancreatic head resection In order to improve the long-term outcome in patients with CP and to limit the resection of pancreatic tissue to a minimum, the duodenum-preserving pancreatic head resection () was introduced by Beger and colleagues [55, 56] in the 197s. The rationale for this
3 J Hepatobiliary Pancreat Sci (21) 17: surgical procedure is to remove the inflammatory mass in the pancreatic head, thereby achieving sufficient bile and pancreatic drainage and decompression of the duodenum and the neighboring vasculature, as well as removal of the inflammatory substrate causing pain. At the same time the duodenum is preserved to allow physiologic food passage and hormonal secretion. Beger s is a less traumatic surgical procedure than the more extensive PD or pppd and is specifically tailored to CP. In Beger s operation the pancreatic head and body are exposed in their entirety by division of the gastrocolic ligament and caudal mobilization of the hepatic colon flexure, followed by a Kocher maneuver. The right gastroepiploic vessels are divided to give full exposure of the pancreas as well as the superior mesenteric and portal veins. In the next step the pancreas is divided above the portal vein and the inflammatory mass is removed from the pancreatic head, leaving a 5- to 8-mm rim of tissue adjacent to the duodenal wall (Fig. 1(1a)). Reconstruction is achieved by means of a Roux-Y jejunal loop with an endto-side anastomosis to the pancreatic body and a side-toside anastomosis to the excavated pancreatic head (Fig. 1(1b)). In cases of a fixed bile duct stricture that is not released by removal of the surrounding pancreatic parenchyma, the bile duct can be incised and integrated into the pancreatic head anastomosis. Berne modification of Beger s operation The technically demanding Beger s operation has undergone several modifications. One of these is the Frey s operation, in which a limited excavation of the pancreatic head is combined with a longitudinal pancreaticojejunostomy (Fig. 1(2a, b)) [57, 58]. In this variant, the dissection of the pancreas from the portal vein and the transection of the pancreas are not necessary. This is especially noteworthy, as this step can be time-consuming and complication-prone as patients with CP may exhibit inflammatory portal vein encasement and portal hypertension. The Berne modification (Berne DPPR), developed in the 199s, [59] aims to combine the advantages of Beger s and Frey s operations. Contrary to Beger s, the pancreas is not transected in the Berne modification, but rather, the anterior capsule of the pancreatic head is incised and the enlarged inflammatory mass is removed almost in its entirety, leaving only a thin rim of pancreatic tissue (Fig. 1(3a)). In this way a continuous cave consisting of the dorsal capsule and a small bridge of pancreatic tissue remains that is then incorporated into a single side-to-side anastomosis with an interposed Roux-Y jejunal loop (Fig. 1(3b)). The common bile duct is frequently incised and included in the pancreatic anastomosis to ensure adequate biliary drainage. As with Beger s operation, the pancreatic duct should be explored intraoperatively and if Fig. 1 Schematic drawing of duodenum-preserving pancreatic head resection () procedures. Extent of resection is shown for Beger s operation (1a) and Frey s operation (2a), as well as the Berne modification (3a). The lower panels (1b, 2b, 3b) show the corresponding surgical sites after reconstruction. (Reprinted with permission from Müller et al. [73])
4 738 J Hepatobiliary Pancreat Sci (21) 17: stenoses are present distally, it can be incised in the body and tail region and anastomosed to the jejunal loop, as was proposed by Frey. Outcome of Beger s operation Beger s has become a well-established and thoroughly analyzed surgical procedure. Several studies have established that Beger s is a safe operation, with mortality rates ranging between and 2%, and morbidity rates ranging between 15 and 54% [6 63]. Furthermore, long-term pain relief is achieved in approximately 8% of patients at 5-year follow up, with a low long-term endocrine insufficiency rate [6 63]. In addition, in terms of quality of life (QOL), 69% of patients were professionally rehabilitated after, and in 72% of patients the Karnofsky index was between 9 and 1% [61]. Given the natural cause of CP, with mortality rates ranging from 2 to 35% over an observation time of years, [1, 64] the death rate after compares favorably with these numbers, ranging between 8.9 and 12.6% in series with a follow up of more than 5 years [61, 63]. Comparison of Beger s operation with PD/ppPD Two RCT have been performed comparing Beger s operation with pancreaticoduodenectomies (PD or pppd) [4, 62] (Table 1). In the study by Klempa et al. [4] 43 patients were randomized to either undergo Beger s operation (22 patients) or PD (21 patients) for CP. After a follow-up period of 3.5 to 5 years, comparable numbers of patients were completely pain free in the two groups (7% vs. 6% PD). However, the mean hospital stay was significantly shorter (16.5 vs days), exocrine insufficiency occurred significantly less often (1 vs. 1%), and postoperative weight gain occurred significantly more often in patients in the DHPPR group than in the PD group (8 vs. 3%). Similar results were reported in a RCT by Büchler et al. [62] comparing Beger s (2 patients) to pppd (2 patients). The mean follow-up period, however, was shorter than that in the study by Klempa et al. [4] (only 6 months). In this study there was a clear trend towards superior pain relief in the group compared to the pppd group (75 vs. 4%). Furthermore, although no significant differences in the frequency of weight gain ( 88% vs. pppd 67%) were reported, the average weight gain in the group was significantly higher than that in the pppd group (4.1 ±.9 vs. 1.9 ± 1.2 kg). In addition, the endocrine function seemed to be better preserved in the group, since after 6 months pathologic glucose tolerance was apparent in the pppd group (mean, 13 mg/dl after 15 min) compared to 88 mg/dl in the group. A third RCT comparing pppd to Beger s, performed by Makowiec et al., has not yet been published in a peer-reviewed journal [65]. Preliminary data, however, show a reduced operation time in the group (368 vs. 435 min), but the data have failed to show any differences in QOL between the two groups. Contrary to this study, a nonrandomized controlled trial by Witzigmann, comparing Beger s to PD, reported better outcomes in the group [44, 45]. A long-term (5 year) follow up of this study confirmed the superiority of Beger s over the classical Whipple operation in terms of QOL and pain intensity [66]. Recently, a long-term (7- and 14-year) follow up of the RCT by Büchler et al. [62] was published [67]. Five of the 2 patients enrolled in each group died during a follow-up period of 14 years. The 5-year survival rate was 9% in both groups. Deaths were due to comorbidities common in patients with CP (liver cirrhosis, renal insufficiency, myocardial infarction, etc.). Contrary to the initial results after 6 months, evaluation of pain showed no differences between the two groups at 7 and 14 years follow up. Furthermore, no significant difference in the onset of diabetes mellitus was apparent between the two groups (at 14 years, 4 of 11 patients in the Beger group compared to 6 of 9 patients in the pppd group). In addition, evaluation of the QOL was similar in the two groups, the only marked difference being appetite loss, which was more pronounced in the pppd group (p =.44). Interestingly, patient judgment after 14 years demonstrated a significant advantage in terms of subjective wellbeing in the Beger group (p =.22). In summary, the significant initial advantages of Beger s in comparison with pppd were less apparent after a prolonged follow up of 7 to 14 years. It should be mentioned, however, that the long-term follow up was hampered by a small number of patients being analyzed. Another point is noteworthy; namely, that two patients in the Beger group required reoperation (one for common bile duct stenosis, one for stenosis of the pancreaticojejunostomy), indicating a potential disadvantage of the organ-sparing in comparison to the more radical pppd. Based on the currently available data, significant advantages of the Beger s operation over PD and pppd exist in terms of weight gain, pain control, and endocrine function for up to 4 years after surgery. Improved rehabilitation, endocrine function, and QOL persist even after this time. We therefore regard Beger s as superior to PD or pppd in the surgical treatment of CP, if it can be applied. Comparison of Beger s operation with Frey s procedure Two RCTs have been performed to compare Beger s operation with the modification introduced by Frey [68,
5 J Hepatobiliary Pancreat Sci (21) 17: Table 1 Selected trials comparing different surgical approaches to chronic pancreatitis Study (ref. no.) Year Design Comparison n Overall postoperative morbidity, DGE, fistula, hemorrhage Mortality Blood Replacement (units), OR time, hospital stay in days (range) Complete pain relief Weight gain, average weight gain (kg) New-onset DM exocrine insufficiency Quality of life Mean Global health status on EORTC-QLQ-3 (SD) Klempa et al. [4] Büchler et al. [62] Müller et al. [67] Long-term F/U of Büchler trial a 1995 RCT (Ib) PD (57%) 2 (9.5%) 1 (4.8%) 2 (9.5%) (63%) 2 (9.1%) 1 (4.5%) 1995 RCT (Ib) pppd 2 4 (2%) 1 (5%) 2 3 (15%) 2 (1%) (%) (16 36) 1 (5%) (13 22) (9 37) (8 21) 12 of 2 (6%) 6/2 (3%) 4.9 ± of 2 (7%) 16/2 (8%) 6.4 ± of 15 (4%) 1/15 (67%) 1.9 ± of 16 (75%) 14/16 (88%) 4.1 ±.9 6/16 (38%) 2 (1%) 2/17 (12%) 2 (1%) 28 RCT (Ib) pppd 14 (5 dead, 1 See above 5/19 (26.3%) See above No difference 6/ (34.2) lost to F/U) 15 (5 dead) See above 5/2 (25%) See above 4/11 65 (22.3) Farkas et al. [74] 26 RCT (Ib) pppd 2 8 (4%) 6 (3%) (Berne) ± ± ± ±.9 18 (9%) 6 (3%) 3.2 ±.3 17 (85%) 15 (75%) 7.8 ±.9 11 (55%) 5 (25%)
6 74 J Hepatobiliary Pancreat Sci (21) 17: Table 1 continued Study (ref. no.) Year Design Comparison n Overall postoperative morbidity, DGE, fistula, hemorrhage Mortality Blood Replacement (units), OR time, hospital stay in days (range) Complete pain relief Weight gain, average weight gain (kg) New-onset DM exocrine insufficiency Quality of life Mean Global health status on EORTC-QLQ-3 (SD) Köninger et al. [75] Izbicki et al. [68] Izbicki et al. [69] Strate et al. [7] Long-term F/U of Izbicki 1997 trial 28 RCT (Ib) (Berne) 1995 RCT (Ib) (Frey) 1997 RCT (Ib) (Frey) 25 RCT (Ib) (Frey) 32 b 6 (2%) 2 (6%) 1 (3%) 33 b 7 (21%) 1 (3%) 1 (3%) 2 4 (2%) 1 (5%) 1 (5%) 22 2 (9%) 1 (4.5%) (32%) 3 (8%) 2 (5%) 36 8 (22%) 2 (6%) 1 (3%) 26 (8 dead, 4 lost to F/U) 25 (8 dead, 3 lost to F/U) 8 (27% pat) 369 ± (8 47) 6 (2%pat) 323 ± (8 39) 3.83 ± ± ± ± 89 2 (5% pat) 315 ± 91 1 (3% pat) 284 ± (at discharge).4 (at discharge) 95% 9% 6.7 ± % 77% 6.4 ± % 74% 6.4 ± % 69% 6.2 ± ± ± (8%) 2 (6%) See above 8/34 See above No difference 14/25 between 22/25 (88%) See above 8/33 See above procedures 15/25 18/23 (6%) No difference between the two procedures No difference between the two procedures No difference between the two procedures
7 J Hepatobiliary Pancreat Sci (21) 17: Table 1 continued Quality of life Mean Global health status on EORTC-QLQ-3 (SD) New-onset DM exocrine insufficiency Weight gain, average weight gain (kg) Complete pain relief Mortality Blood Replacement (units), OR time, hospital stay in days (range) Year Design Comparison n Overall postoperative morbidity, DGE, fistula, hemorrhage Study (ref. no.) 66.4 ± /55 (22%) 56/73 (77) 49/73 (67%) Pain improved in 55% 1 (1%).15 ( 8) 295 ± ± (23%) 1 (1%) 1 (1%) 3 (3%) 28 Prospective study (Berne) Müller et al. [73] Evidence level Ib: individual properly designed randomized controlled trial; Evidence level IIb: individual well-designed controlled trial without randomization, retrospective cohort study PD, pancreaticoduodenectomy; pppd, pylorus-preserving PD;, duodenum-preserving pancreatic head resection; DGE delayed gastric emptying; DM diabetes mellitus; RCT randomized controlled trial. NRCT: non-randomized controlled trial. SD standard deviation. not available; EORTC European Organization for Research and Treatment of Cancer; F/U follow up Data shown for 14-year follow up In the trial of Köninger et al., 8 patients in the Beger group and 6 in the Berne group were converted to other procedures during the initial operation, but were included in the intention-to-treat analysis a b 69]. These studies showed comparable levels of pain relief (ranging between 93 and 95%) and control of complications to adjacent organs (91% Frey, 92% Beger), as well as improvement in the QOL (58 67% increase in the overall QOL index). Furthermore, endocrine and exocrine function of the pancreas were not significantly different between the two groups. A long-term follow up (median, 14 months) of one of these studies [69] showed that there was no difference in late mortality (31 vs. 32%), endocrine or exocrine function, or pain scores (Izbicki pain scores, vs ) or QOL (European Organization for Research and Treatment of Cancer [EORTC] global QOL 66.7 vs ) [7]. Results of the Berne operation The Berne modification of Beger s procedure [59] was initially evaluated in several smaller studies [71, 72]. Farkas et al. reported 3 patients who, after a mean follow up of 1 months, were all symptom-free, had experienced no severe complications, and showed enhanced endocrine and exocrine function [71]. Similar results were reported by Andersen and Topazian [72]. Recently, the prospectively evaluated data of a large series of 1 consecutive CP patients treated with the Berne operation at a single institution were published [73]. With a low postoperative mortality rate (1%) and low surgical morbidity (16%), as well as pain improvement in 55% of all patients, weight gain in 67%, and QOL comparable to that of a healthy control population at a mean follow up of 41 months, the Berne modification has become an established option for the treatment of CP. Two randomized trials have been reported up to now comparing the Berne procedure either to pppd [74] or to Beger s operation [75]. Farkas and colleagues randomly assigned 4 patients to either undergo the Berne operation (2 patients) or pppd (2 patients). Operation time was significantly shorter in the Berne group (142 ± 4.9 vs. 278 ± 6.9 min for pppd), as was the duration of hospital stay (Berne 8.5 ±.9 days vs ± 3.9 for pppd). In this study, postoperative morbidity was markedly increased in the pppd group (Berne % vs. pppd 4%), largely due to an unexpectedly high morbidity in the pppd group not reported in other studies (see Table 1). At follow up (1 year) there was no significant difference in complete pain relief (Berne 85% vs. 9% pppd); however, weight gain occurred in significantly more patients in the Berne subgroup (75 vs. 3% in the pppd group), with an average weight gain of 7.8 ±.9 kg versus only 3.2 ±.3 kg in the pppd group. Furthermore, patients in the Berne group exhibited a significantly better QOL. Köninger et al. conducted a RCT comparing Beger s original to the Berne modification [75]. In this trial
8 742 J Hepatobiliary Pancreat Sci (21) 17: patients were randomly assigned to undergo either Beger s operation (32 patients) or the Berne modification (33 patients). The primary end point of this analysis was operation time, which was significantly shorter in the Berne group than in the Beger group (323 ± 56 vs. 369 ± 91 min, p =.2). Furthermore, mean hospital stay was shorter in the Berne group (11 vs. 15 days, p =.15). QOL did not differ significantly after 2 years between the two groups regarding the EORTC-QLQ-3 questionnaire (Beger 65.5% vs. Berne 71.3%). A significant difference found between the two groups on the pancreas-specific EORTC-PAN questionnaire in favor of the Berne procedure (Beger 63.9% vs. Berne 75.8%) persisted only in the intention-to-treat analysis. In the per-protocol analysis, operation time remained the only significant difference between the two procedures. Notably, 11 patients (6 in the Beger group and 5 in the Berne group) required readmission to hospital and reoperation due to the disease. Three of the Berne group patients were operated on due to ongoing pancreatitis and bile duct obstruction, indicating the importance of removing as much pancreatic head tissue as possible during the operation. In summary, the Berne modification seems to be equally suited for the treatment of CP as the original Beger s operation. Conclusion Beger s and the Berne and other modifications are by now well-established and analyzed procedures for the treatment of CP. Both the Beger and the Berne procedures, as well as the other modifications, are organsparing pancreatic head resections specifically tailored for the treatment of CP. The superior outcome of these procedures over pancreaticoduodenectomies (PD or pppd) in terms of weight gain and pain control, as well as endocrine and intestinal function, make them the ideal treatment options for patients requiring surgery for CP, although after long-term follow up some of the initial advantages are lost. References 1. Singer MV, Gyr K, Sarles H. Second symposium on the classification of pancreatitis. Marseilles, 28 3 March Acta Gastroenterol Belg. 1985;48(6): Otsuki M. Chronic pancreatitis. The problems of diagnostic criteria. Pancreatology. 24;4(1): Sarles H. Classification and definition of pancreatitis. Marseilles- Rome Gastroenterol Clin Biol. 1989;13(11): Otsuki M, Tashiro M. 4. Chronic pancreatitis and pancreatic cancer, lifestyle-related diseases. Int Med. 27;46(2): Pedersen NT, Worning H. Chronic pancreatitis. Scand J Gastroenterol Suppl. 1996;216: Díte P, Star K, Novotn I, et al. Incidence of chronic pancreatitis in the Czech Republic. Eur J Gastroenterol Hepatol. 21;13(6): Lévy P, Barthet M, Mollard BR, et al. Estimation of the prevalence and incidence of chronic pancreatitis and its complications. Gastroenterol Clin Biol. 26;3(6 7): Saisho H, Otsuki M. Epidemiological survey of pancreatitis in Japan. Annual report of the Research Committee of intractable Pancreatic Disease. 22: Stevens T, Conwell DL, Zuccaro G. Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments. Am J Gastroenterol. 24;99(11): Lankisch PG. Natural course of chronic pancreatitis. Pancreatology. 21;1(1): Lankisch PG, Seidensticker F, Löhr-Happe A, Otto J, Creutzfeldt W. The course of pain is the same in alcohol- and nonalcoholinduced chronic pancreatitis. Pancreas. 1995;1(4): Layer P, Yamamoto H, Kalthoff L, et al. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994;17(5): Rösch T, Daniel S, Scholz M, et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1 patients with long-term follow-up. Endoscopy. 22;34(1): Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 27;356(7): Díte P, Ruzicka M, Zboril V, Novotn I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 23;35(7): Ekbom A, McLaughlin JK, Karlsson BM, et al. Pancreatitis and pancreatic cancer: a population-based study. J Natl Cancer Inst. 1994;86(8): Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med. 1993;328(2): Lowenfels AB, Maisonneuve P, Cavallini G, et al. Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol. 1994; 89(9): Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg. 196; 152: Delcore R, Rodriguez FJ, Thomas JH, Forster J, Hermreck AS. The role of pancreatojejunostomy in patients without dilated pancreatic ducts. Am J Surg. 1994;168(6): discussion Bradley EL. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg. 1987;153(2): Nealon WH, Thompson JC. Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified Puestow procedure. Ann Surg. 1993;217(5): discussion Warshaw AL, Banks PA, Fernández-Del Castillo C. AGA technical review: treatment of pain in chronic pancreatitis. Gastroenterology. 1998;115(3): Shrikhande SV, Kleeff J, Friess H, Büchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg. 26;1(2): Markowitz JS, Rattner DW, Warshaw AL. Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis strategies for salvage. Arch Surg. 1994;129(4): discussion
9 J Hepatobiliary Pancreat Sci (21) 17: Strobel O, Büchler MW, Werner J. Duodenum-preserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne modifications. Chirurg. 29; 8(1): Ebbehøj N, Borly L, Bülow J, et al. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function. Scand J Gastroenterol. 199;25(1): Holmberg JT, Isaksson G, Ihse I. Long term results of pancreaticojejunostomy in chronic pancreatitis. Surg Gynecol Obstet. 1985;16(4): Greenlee HB, Prinz RA, Aranha GV. Long-term results of sideto-side pancreaticojejunostomy. World J Surg. 199;14(1): Shrikhande SV, Friess H, di Mola FF, et al. NK-1 receptor gene expression is related to pain in chronic pancreatitis. Pain. 21;91(3): Di Sebastiano P, Fink T, Weihe E, et al. Immune cell infiltration and growth-associated protein 43 expression correlate with pain in chronic pancreatitis. Gastroenterology. 1997;112(5): Büchler M, Weihe E, Friess H, et al. Changes in peptidergic innervation in chronic pancreatitis. Pancreas. 1992;7(2): Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology. 1988;94(6): Karanjia ND, Widdison AL, Leung F, et al. Compartment syndrome in experimental chronic obstructive pancreatitis: effect of decompressing the main pancreatic duct. Br J Surg. 1994; 81(2): Beger HG, Gansauge F, Schwarz M, Poch B. Chronic pancreatitis: inflammatory mass in the head of the pancreas pacemaker of chronic pancreatitis. In: Diseases of the pancreas. 28. p Beger HG, Rau BM, Gansauge F, Poch B. Duodenum-preserving subtotal and total pancreatic head resections for inflammatory and cystic neoplastic lesions of the pancreas. J Gastrointest Surg. 28;12(6): Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of vater. Ann Surg. 1935;12(4): Kausch W. Das Carcinom der Papilla duodeni und seine radikale Entfernung. Beitrg Klin Chir 1912;78: Traverso LW, Longmire WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146(6): Klempa I, Spatny M, Menzel J, et al. Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple s operation. Chirurg. 1995;66(4): Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM. Pancreatoduodenectomy for chronic pancreatitis: long-term results in 15 patients. Arch Surg. 2;135(5): discussion Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL. Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg. 2;231(3): Traverso LW, Kozarek RA. Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Ann Surg. 1997;226(4): discussion Witzigmann H, Max D, Uhlmann D, et al. Quality of life in chronic pancreatitis: a prospective trial comparing classical Whipple procedure and duodenum-preserving pancreatic head resection. J Gastrointest Surg. 22;6(2): discussion Witzigmann H, Max D, Uhlmann D, et al. Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Surgery. 23;134(1): Belina F, Fronek J, Ryska M. Duodenopancreatectomy versus duodenum-preserving pancreatic head excision for chronic pancreatitis. Pancreatology. 25;5(6): Forssmann K, Schirr K, Schmid M, et al. Postoperative follow-up in patients with partial Whipple duodenopancreatectomy for chronic pancreatitis. Z Gastroenterol. 1997;35(12): Zerbi A, Balzano G, Patuzzo R, et al. Comparison between pylorus-preserving and Whipple pancreatoduodenectomy. Br J Surg. 1995;82(7): Mosca F, Giulianotti PC, Balestracci T, et al. Long-term survival in pancreatic cancer: pylorus-preserving versus Whipple pancreatoduodenectomy. Surgery. 1997;122(3): Williamson RC, Bliouras N, Cooper MJ, Davies ER. Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy. Surgery. 1993;114(1): Seiler CA, Wagner M, Sadowski C, Kulli C, Büchler MW. Randomized prospective trial of pylorus-preserving vs. classic duodenopancreatectomy (Whipple procedure): initial clinical results. J Gastrointest Surg. 2;4(5): Diener MK, Heukaufer C, Schwarzer G, et al. Pancreaticoduodenectomy (classic Whipple) versus pylorus-preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 28;(2):CD Jimenez RE, Fernandez-Del Castillo C, Rattner DW, Warshaw AL. Pylorus-preserving pancreaticoduodenectomy in the treatment of chronic pancreatitis. World J Surg. 23;27(11): Keck T, Marjanovic G, Fernandez-del Castillo C, et al. The inflammatory pancreatic head mass: significant differences in the anatomic pathology of German and American patients with chronic pancreatitis determine very different surgical strategies. Ann Surg. 29;249(1): Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery. 1985;97(4): Beger HG, Witte C, Krautzberger W, Bittner R. Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg. 198;51(5): Frey CF, Amikura K. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg. 1994;22(4): discussion Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2(6): Gloor B, Friess H, Uhl W, Büchler MW. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg. 21;18(1): Beger HG, Büchler M, Bittner RR, Oettinger W, Roscher R. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg. 1989;29(3): Beger HG, Schlosser W, Friess HM, Büchler MW. Duodenumpreserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann Surg. 1999;23(4): discussion Büchler MW, Friess H, Müller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg. 1995;169(1):65 9. discussion Büchler MW, Friess H, Bittner R, et al. Duodenum-preserving pancreatic head resection: long-term results. J Gastrointest Surg. 1997;1(1):13 9.
10 744 J Hepatobiliary Pancreat Sci (21) 17: Miyake H, Harada H, Kunichika K, Ochi K, Kimura I. Clinical course and prognosis of chronic pancreatitis. Pancreas. 1987; 2(4): Makowiec F, Hopt UT, Adam U. Randomized controlled trial of ppwhipple vs. duodenum-preserving pancreatic head resection in chronic pancreatitis Möbius C, Max D, Uhlmann D, et al. Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis. Langenbecks Arch Surg. 27;392(3): Müller MW, Friess H, Martin DJ, et al. Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg. 28;95(3): Izbicki JR, Bloechle C, Knoefel WT, et al. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial. Ann Surg. 1995;221(4): Izbicki JR, Bloechle C, Knoefel WT, et al. Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study. Chirurg. 1997;68(4): Strate T, Taherpour Z, Bloechle C, et al. Long-term follow-up of a randomized trial comparing the Beger and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg. 25; 241(4): Farkas G, Leindler L, Daróczi M, Farkas G. Organ-preserving pancreatic head resection in chronic pancreatitis. Br J Surg. 23;9(1): Andersen DK, Topazian MD. Pancreatic head excavation: a variation on the theme of duodenum-preserving pancreatic head resection. Arch Surg. 24;139(4): Müller MW, Friess H, Leitzbach S, et al. Perioperative and follow-up results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis. Am J Surg. 28;196(3): Farkas G, Leindler L, Daróczi M, Farkas G. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy. Langenbecks Arch Surg. 26;391(4): Köninger J, Seiler CM, Sauerland S, et al. Duodenum-preserving pancreatic head resection a randomized controlled trial comparing the original Beger procedure with the Berne modification (ISRCTN No ). Surgery. 28;143(4):49 8.
Resection vs Drainage in Treatment of Chronic Pancreatitis: Long-term Results of a Randomized Trial
GASTROENTEROLOGY 2008;134:1406 1411 Resection vs Drainage in Treatment of Chronic Pancreatitis: Long-term Results of a Randomized Trial TIM STRATE,* KAI BACHMANN,* PHILIPP BUSCH,* OLIVER MANN,* CLAUS SCHNEIDER,*
More informationSurgical Treatment of Pain in Patients with Chronic Pancreatitis
PANCREAS Surgical Treatment of Pain in Patients with Chronic Pancreatitis Alexander Victorovich Prochorov 1, Karl-Jurgen Oldhafer 2, Stanislaw Ivanovich Tretyak 3, Siarhei Markovich Rashchynski 3,4, Marcello
More informationPatients with chronic pancreatitis suffering from severe
RANDOMIZED, CONTROLLED TRIALS Long-term Follow-up of a Randomized Trial Comparing the Beger and Frey Procedures for Patients Suffering From Chronic Pancreatitis Tim Strate, MD,* Zohre Taherpour, MD,* Christian
More informationPatient characteristics Intervention Comparison Length of follow-up. Endoscopic treatment. Endoscopic transampullary drainage of the pancreatic duct
1) In patients with alcohol-related, what is the safety and efficacy of a) coeliac access block vs medical management b) thoracoscopic splanchnicectomy vs medical management c) coeliac access block vs
More informationInternational Journal of Surgery
International Journal of Surgery 7 (2009) 305 312 Contents lists available at ScienceDirect International Journal of Surgery journal homepage: www.theijs.com Review Surgical therapy of chronic pancreatitis:
More informationIncapacitating pain of chronic pancreatitis: a surgical perspective of what is known and what needs to be known
Incapacitating pain of chronic pancreatitis: a surgical perspective of what is known and what needs to be known Michael G. Sarr, MD, George H. Sakorafas, MD Rochester, Minnesota In a select population
More informationChronic Pancreatitis
Gastro Foundation Fellows Weekend 2017 Chronic Pancreatitis Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Aetiology in SA Alcohol (up to 80%) Idiopathic Tropical Obstruction Autoimmune
More informationSurgical Management of Chronic Pancreatitis VERENA LIU, MD KINGS COUNTY HOSPITAL CENTER SURGERY GRAND ROUNDS 4/1/2013
Surgical Management of Chronic Pancreatitis VERENA LIU, MD KINGS COUNTY HOSPITAL CENTER SURGERY GRAND ROUNDS 4/1/2013 Case Report 42F with h/o chronic pancreatitis due to alcohol use with chronic upper
More informationAdvances in surgical treatment of chronic pancreatitis
Ni et al. World Journal of Surgical Oncology (2015) 13:34 DOI 10.1186/s12957-014-0430-4 WORLD JOURNAL OF SURGICAL ONCOLOGY REVIEW Advances in surgical treatment of chronic pancreatitis Qingqiang Ni 1,2,3,
More informationShort- and Long-term Results of Modified Frey s Procedure in Patients with Chronic Pancreatitis: A Retrospective Japanese Single-Center Study
Kobe J. Med. Sci., Vol. 60, No. 2, pp. E30-E36, 2014 Short- and Long-term Results of Modified Frey s Procedure in Patients with Chronic Pancreatitis: A Retrospective Japanese Single-Center Study MASAKI
More informationReview Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future
Hindawi Gastroenterology Research and Practice Volume 2017, Article ID 8418372, 6 pages https://doi.org/10.1155/2017/8418372 Review Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and
More informationPrevention Of Pancreaticojejunal Fistula After Whipple Procedure
ISPUB.COM The Internet Journal of Surgery Volume 4 Number 2 Prevention Of Pancreaticojejunal Fistula After Whipple Procedure N Barbetakis, K Setsiz Citation N Barbetakis, K Setsiz. Prevention Of Pancreaticojejunal
More informationP. Hildebrand 1, S. Dudertadt 2, R. czymek 1, f. g. Bader 1, u. J. Roblick 1, H.-P. Bruch 1, t. Jungbluth 1
august 20, 2010 Eu Ro PE an JouR nal of MED I cal RE SEaRcH 351 Eur J Med Res (2010) 15: 351-356 I. Holzapfel Publishers 2010 DIffEREnt SuRgIcal StRatEgIES for chronic PancREatItIS SIgnIfIcantly IMPRovE
More informationCHRONIC PANCREATITIS CONSERVATIVE TREATMENT, ENDOSCOPY OR SURGERY?
Endoscopy 2006 Update and Live Demonstration Berlin, 04. 05. Mai 2006 CHRONIC PANCREATITIS CONSERVATIVE TREATMENT, ENDOSCOPY OR SURGERY? J. F. Riemann A. Rosenbaum Medizinische Klinik C, Klinikum Ludwigshafen
More informationWe are IntechOpen, the first native scientific publisher of Open Access books. International authors and editors. Our authors are among the TOP 1%
We are IntechOpen, the first native scientific publisher of Open Access books 3,350 108,000 1.7 M Open access books available International authors and editors Downloads Our authors are among the 151 Countries
More informationPylorus Preserving Pancreaticoduodenectomy
REVIEW Pylorus Preserving Pancreaticoduodenectomy Jacqueline M. Garonzik-Wang, M. B. Majella Doyle Pancreaticoduodenectomy (PD) has become the standard of care for resectable pancreatic cancer and premalignant
More informationIndex (SIRS), 158, 173
Index A Acute pancreatitis surgery abdominal compartment syndrome, 188 adjuvant treatment, 194 anterior approach, 175 antibiotic prophylaxis, 166 167, 197 Atlanta classification, 181 classification of
More informationLong-term Outcomes of Endoscopic vs Surgical Drainage of the Pancreatic Duct in Patients With Chronic Pancreatitis
GASTROENTEROLOGY 2011;141:1690 1695 CLINICAL PANCREAS Long-term Outcomes of Endoscopic vs Surgical Drainage of the Pancreatic Duct in Patients With Chronic Pancreatitis DJUNA L. CAHEN,* DIRK J. GOUMA,
More informationPancreas-Preserving Total Duodenectomy
How I do it Dig Surg 1998;15:398 403 Gregory G. Tsiotos Michael G. Sarr Division of Gastroenterologic and General Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn., USA Pancreas-Preserving
More informationPylorus Preserving Pancreaticoduodenectomy: Superior to Classic Pancreaticoduoenectomy
Pylorus Preserving Pancreaticoduodenectomy: Superior to Classic Pancreaticoduoenectomy David Mauchley, MD University of Colorado, Denver Department of Surgery Grand Rounds December 14 th, 2009 Pancreatic
More informationOverview. Doumit S. BouHaidar, MD ACG/VGS/ODSGNA Regional Postgraduate Course Copyright American College of Gastroenterology 1
Doumit S. BouHaidar, MD Associate Professor of Medicine Director, Advanced Therapeutic Endoscopy Virginia Commonwealth University Overview Copyright American College of Gastroenterology 1 Incidence: 4
More informationCLASSIFICATION OF CHRONIC PANCREATITIS
CLASSIFICATION OF CHRONIC PANCREATITIS EAGE, Podstgraduate Course, Prague, April 2010. Tomica Milosavljević School of Medicine, University of Belgrade Clinical Center of Serbia,Belgrade The phrase chronic
More informationChallenging dogmas in pancreatic surgery: biliary drainage, outcome and beyond van der Gaag, N.A.
UvA-DARE (Digital Academic Repository) Challenging dogmas in pancreatic surgery: biliary drainage, outcome and beyond van der Gaag, N.A. Link to publication Citation for published version (APA): van der
More informationCuneyt Kayaalp, Murat Sait Dogan, and Veysel Ersan. Department of Surgery, Inonu University, Malatya, Turkey
Ann Hepatobiliary Pancreat Surg 2017;21:101-105 https://doi.org/10.14701/ahbps.2017.21.2.101 Case Report Surgery for intractable pain in a patient with chronic pancreatitis complicated with biliary obstruction,
More informationTRIALS. Open Access STUDY PROTOCOL. Study protocol. BioMed Central
TRIALS STUDY PROTOCOL Open Access Study protocol ChroPac-Trial: Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled
More informationSingle Jejunal Limb Restoration Of Gastrointestinal. continuity following pancreaticoduodenectomy
ISPUB.COM The Internet Journal of Surgery Volume 28 Number 3 Single Jejunal Limb Restoration Of Gastrointestinal Continuity Following Pancreaticoduodenectomy L Allopi, B Singh, S Cheddie, A Haffejee Citation
More informationSurgical Treatment for Periampullary Carcinoma A Study of 129 Patients*)
Hiroshima Journal of Medical Sciences Vol. 33, No. 2, 179,...183, June, 1984 HJM 33-24 179 Surgical Treatment for Periampullary Carcinoma A Study of 129 Patients*) Tsuneo TAN AKA, Motomu KODAMA, Rokuro
More informationTHE CRITICAL COMPLCATIONS AND MANAGEMENTS AFTER PANCREATIC SURGERY 2013/12/21
THE CRITICAL COMPLCATIONS AND MANAGEMENTS AFTER PANCREATIC SURGERY Tsann-Long Hwang, MD, FACS Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taipei, TAIWAN 2013/12/21 THE DIFFICULTY
More informationEarly View Article: Online published version of an accepted article before publication in the final form.
: Online published version of an accepted article before publication in the final form. Journal Name: International Journal of Hepatobiliary and Pancreatic Diseases (IJHPD) Type of Article: ORIGINAL ARTICLE
More informationORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2007;5:1085 1091 ORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT Recurrent Flares of Pancreatitis Predict Development of Exocrine Insufficiency in Chronic
More informationThe Whipple Operation Illustrations
The Whipple Operation Illustrations Fig. 1. Illustration of the sixstep pancreaticoduodenectomy (Whipple operation) as described in a number of recent text books by Dr. Evans. The operation is divided
More informationThe role of ERCP in chronic pancreatitis
The role of ERCP in chronic pancreatitis Marianna Arvanitakis Erasme University Hospital, ULB, Brussels, Belgium 10 th Nottingham Endoscopy Masterclass SPEAKER DECLARATIONS This presenter has the following
More informationKey words: acute pancreatitis, chronic pancreatitis, necrosectomy. Table I. Surgical procedure for acute pancreatitis.
Key words: acute pancreatitis, chronic pancreatitis, necrosectomy Table I Surgical procedure for acute pancreatitis Schmieden 1928 Drainage for retroperitoneal cavity Waterman,rU, Peripancreatic drainage
More information16 April 2010 Resident Teaching Conference. Pancreatitis. W. H. Nealon, M.D., F.A.C.S. J.J. Smith, M.D., D.W.D.
16 April 2010 Resident Teaching Conference Pancreatitis W. H. Nealon, M.D., F.A.C.S. J.J. Smith, M.D., D.W.D. Santorini Wirsung anatomy.med.umich.edu/.../ duodenum_ans.html Bud and ductology Ventral pancreatic
More informationNew developments in diagnosis and non-surgical treatment of chronic pancreatitis
bs_bs_banner doi:10.1111/jgh.12250 NUTRITIONAL FACTORS IN PANCREATOBILIARY DISORDERS New developments in diagnosis and non-surgical treatment of chronic pancreatitis Kazuo Inui, Junji Yoshino, Hironao
More informationJOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES
JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES THE PROBLEM DUODENAL / PANCREATIC INJURIES Difficult to diagnose Not very common Anatomic and physiologic challenges 90% rate of associated
More informationCongenital dilatation of the common bile duct and pancreaticobiliary maljunction clinical implications
Langenbecks Arch Surg (2009) 394:209 213 DOI 10.1007/s00423-008-0330-6 CURRENT CONCEPT IN CLINICAL SURGERY Congenital dilatation of the common bile duct and pancreaticobiliary maljunction clinical implications
More informationChronic Pancreatitis: When to Scope? Gregory A. Cote, MD, MS Assistant Professor of Medicine Indiana University School of Medicine
Chronic Pancreatitis: When to Scope? Gregory A. Cote, MD, MS Assistant Professor of Medicine Indiana University School of Medicine Endoscopy & Chronic Pancreatitis Diagnosis EUS ERCP Exocrine Function
More informationQuality of Life in Chronic Pancreatitis
Pancreas Quality of Life in Chronic Pancreatitis Emily Grist, 1 James Jupp 2 and Colin D Johnson 3 1. Foundation Trainee, Department of Surgery, Southampton General Hospital; 2. Pancreatic Research Registrar,
More informationBILIARY TRACT & PANCREAS, PART II
CME Pretest BILIARY TRACT & PANCREAS, PART II VOLUME 41 1 2015 A pretest is mandatory to earn CME credit on the posttest. The pretest should be completed BEFORE reading the overview. Both tests must be
More informationPancreaticoduodenectomy the anatomy and the surgical approaches
Pancreaticoduodenectomy the anatomy and the surgical approaches Paul BS LAI Division of Hepato biliary and Pancreatic Surgery Department of Surgery The Chinese Univesity of Hong Kong Whipple s operation
More informationTreatment of chronic calcific pancreatitis endoscopy versus surgery
Treatment of chronic calcific pancreatitis endoscopy versus surgery 35 - year old ladypresented to LPC Mumbai with intermittent abdominal pain. Pain was intermittent, colicky, more in epigastrium and periumbilical
More informationClinical Efficacy of Organ-Preserving Pancreatectomy for Benign or Low-Grade Malignant Potential Lesion
J Korean Med Sci 2010; 25: 97-103 ISSN 1011-8934 DOI: 10.3346/jkms.2010.25.1.97 Clinical Efficacy of Organ-Preserving Pancreatectomy for Benign or Low-Grade Malignant Potential Lesion The clinical usefulness
More informationCauses of pancreatic insufficiency. Eugen Dumitru
Causes of pancreatic insufficiency Eugen Dumitru Pancreatic Exocrine Insufficiency (PEI) 1. The Concept 2. The Causes 3. The Consequences Pancreatic Exocrine Insufficiency (PEI) 1. The Concept 2. The Causes
More informationKey Words: bile duct obstruction, biliary drainage, obstructive jaundice, endoscopic drainage
HPB, 2007; 9: 408413 PRESIDENTIAL ADDRESS Stent versus surgery DIRK J. GOUMA Abstract Following the introduction of percutaneous and endoscopic biliary drainage there has been an ongoing debate about the
More informationCitation Hepato-Gastroenterology, 55(86-87),
NAOSITE: Nagasaki University's Ac Title Author(s) Combined pancreatic resection and p multiple lesions of the pancreas: i of the pancreas concomitant with du Kuroki, Tamotsu; Tajima, Yoshitsugu Tomohiko;
More informationSerous Cystic Neoplasm: Do We Have to Wait Till It Causes Trouble?
Korean Journal of HBP Surgery Case Report Vol. 15, No. 2, May 2011 Serous Cystic Neoplasm: Do We Have to Wait Till It Causes Trouble? Serous cystic neoplasm (SCN) of the pancreas is considered a benign
More informationYoshitsugu; Kanematsu, Takashi; Kur
NAOSITE: Nagasaki University's Ac Title Author(s) Citation Laparoscopic Middle Pancreatectomy Surgery Kitasato, Amane; Adachi, Tomohiko; Yoshitsugu; Kanematsu, Takashi; Kur Hepato-Gastroenterology, 59(120),
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, pancreatic ductal, laparoscopic distal pancreatectomy for, 61 Adrenal cortical carcinoma, laparoscopic adrenalectomy for, 114
More informationChronic Pancreatitis: Surgical Options. W. Charles Conway MD, FACS Upper GI/HPB Surgical Oncology Ochsner Medical Center New Orleans, LA
Chronic Pancreatitis: Surgical Options W. Charles Conway MD, FACS Upper GI/HPB Surgical Oncology Ochsner Medical Center New Orleans, LA Chronic Pancreatitis Recurrent, debilitating abdominal pain with
More informationNavigating the Biliary Tract with CT & MR: An Imaging Approach to Bile Duct Obstruction
Navigating the Biliary Tract with CT & MR: An Imaging Approach to Bile Duct Obstruction Ann S. Fulcher, MD Medical College of Virginia Virginia Commonwealth University Richmond, Virginia Objectives To
More informationFat Tissue Infiltration into the Pancreas Parenchyme and Its Effect on the Result of Surgery
Korean Journal of HBP Surgery Vol. 15,. 2, May 2011 O riginal Article Fat Tissue Infiltration into the Pancreas Parenchyme and Its Effect on the Result of Surgery Purpose: In Korea, there are few reports
More informationEndoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy
Diagnostic and Therapeutic Endoscopy, Vol. 3, pp. 35-40 Reprints available directly from the publisher Photocopying permitted by license only (C) 1996 OPA (Overseas Publishers Association) Amsterdam B.V.
More informationAn Innovative Option for Venous Reconstruction After Pancreaticoduodenectomy: the Left Renal Vein
J Gastrointest Surg (2007) 11:425 431 DOI 10.1007/s11605-007-0131-1 An Innovative Option for Venous Reconstruction After Pancreaticoduodenectomy: the Left Renal Vein Rory L. Smoot & John D. Christein &
More informationСтенты «Ella-cs» Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts»
Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts» A. Esophageal Stenting and related topics 1 AMJG 2009; 104:1329 1330 Letters to Editor Early Tracheal Stenosis Post Esophageal Stent
More informationORIGINAL ARTICLE. Fate of the Pancreatic Remnant After Resection for an Intraductal Papillary Mucinous Neoplasm
ONLINE FIRST ORIGINAL ARTICLE Fate of the Pancreatic Remnant After Resection for an Intraductal Papillary Mucinous Neoplasm A Longitudinal Level II Cohort Study Toshiyuki Moriya, MD, PhD; L. William Traverso,
More informationRisk of reverse causation (only 1 year lag period between pancreatitis and cancer)
Supplementary Table 1. Main risk of bias in the included studies. Study Main risk of bias Anderson, 2009 Differential participation (45% cases, 83% controls) 11% proxy respondents Risk of recall bias Self-reported
More informationManagement of Pancreatic Fistulae
Management of Pancreatic Fistulae Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Fistula definition A Fistula is a permanent abnormal passageway between two organs (epithelial
More informationPancreatic Head Mass, How Can We Treat It? Chronic Pancreatitis: Surgical Treatment
4 th Joint Meeting of Italian-Hungarian Pancreatologists CAPRI (ITALY). SEPTEMBER 30 th, 2000 Pancreatic Head Mass, How Can We Treat It? Chronic Pancreatitis: Surgical Treatment Massimo Falconi, Loca Casetti,
More information5/17/2013. Pancreatic Cancer. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Case presentation. Differential diagnosis
Overview Case presentation Postgraduate Course in General Surgery Differential diagnosis Diagnosis and therapy Eric K. Nakakura Koloa, HI March 26, 2013 Outcomes CASE 1: CASE 1: A 78-year-old man developed
More informationPancreaticoduodenectomy
Pancreaticoduodenectomy A Valuable Surgery Paul Montero PGY-III September 11, 2006 Overview Brief History Perils of Early Pancreaticoduodenectomy (PD) Improvements Quality of Life after PD Widened Indications
More informationPANCREATODUODENECTOMY VERSUS WHIPPLE HEAD OF THE PANCREAS PYLORUS PRESERVING PROCEDURE FOR ADENOCARCINOMA OF THE INTRODUCTION
HPB Surgery 1989, Vol. 1, pp. 195-200 Reprints available directly from the publisher Photocopying permitted by license only (C) 1989 Harwood Academic Publishers GmbH Printed in Great Britain PYLORUS PRESERVING
More informationSafety of pancreatic resection in the elderly: a retrospective analysis of 556 patients
ORIGINAL ARTICLE Annals of Gastroenterology (2016) 29, 1-5 Safety of pancreatic resection in the elderly: a retrospective analysis of 556 patients Daniel Ansari, Linus Aronsson, Joakim Fredriksson, Bodil
More informationEvaluation of the Manchester Classification System for Chronic Pancreatitis
ORIGINAL ARTICLE Evaluation of the Manchester Classification System for Chronic Pancreatitis Anil Bagul, Ajith K Siriwardena Hepatobiliary Surgical Unit, Manchester Royal Infirmary. Manchester, United
More informationSurgical Management of CBD Injury Jin Seok Heo
Surgical Management of CBD Injury Jin Seok Heo Department of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Bile duct injury (BDI) Introduction Incidence
More informationLaparoscopy-assisted D2 radical distal subtotal gastrectomy
Masters of Gastrointestinal Surgery Laparoscopy-assisted D2 radical distal subtotal gastrectomy Xiaogeng Chen, Weihua Li, Jinsi Wang, Changshun Yang Department of Tumor Surgery, Fujian Provincial Hospital,
More informationAnatomical and Functional MRI of the Pancreas
Anatomical and Functional MRI of the Pancreas MA Bali, MD, T Metens, PhD Erasme Hospital Free University of Brussels Belgium mbali@ulb.ac.be Introduction The use of MRI to investigate the pancreas has
More informationChristopher Lau June 16, 2011 SUNY Downstate Brooklyn VA 64 year old male presented with severe epigastric pain radiating to the back, nausea and vomiting History of chronic pancreatitis with recurrent
More informationLate Postpancreatectomy Hemorrhage After Pancreaticoduodenectomy: Is It Possible to Recognize Risk Factors?
ORIGINAL ARTICLE Late Postpancreatectomy Hemorrhage After Pancreaticoduodenectomy: Is It Possible to Recognize Risk Factors? Claudio Ricci, Riccardo Casadei, Salvatore Buscemi, Francesco Minni Department
More informationRadical nerve dissection for the carcinoma of head of pancreas: report of 30 cases
Original Article Radical nerve dissection for the carcinoma of head of pancreas: report of 30 cases Qing Lin, Langping Tan, Yu Zhou, Quanbo Zhou, Rufu Chen Department of Biliary and Pancreatic Surgery,
More information[7] Greene, B. S., Loubeau, J. M., Peoples, J. B. and Elliott, D. W. (1991). Are pancreatoenteric anastomoses improved
136 HPB INTERNATIONAL mosis. In our experience, roughly 10% of patients will have low volume amylase-rich fluid draining via the drains. Over 85% of these low volume pancreatic fistulas will heal with
More informationDiagnosis of chronic Pancreatitis. Christoph Beglinger, University Hospital Basel, Switzerland
Diagnosis of chronic Pancreatitis Christoph Beglinger, University Hospital Basel, Switzerland Pancreatitis Pancreas Pancreas - an organ that makes bicarbonate to neutralize gastric acid, enzymes to digest
More informationCASE 01 LA Path Slide Seminar 13 March, 08. Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center
CASE 01 LA Path Slide Seminar 13 March, 08 Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center Clinical History 60 year old male presented with obstructive jaundice
More informationPancreatic Benign April 27, 2016
Department of Surgery Pancreatic Benign April 27, 2016 James Choi Dr. Hernandez Objectives Medical Expert: 1. Anatomy and congenital anomalies of the pancreas and pancreatic duct (divisum, annular pancreas
More informationReinterventions belong to complications
Reinterventions belong to complications Pancreatic surgery is the archetypus of complex abdominal surgery Mortality (1-4%) and morbidity (7-60%) rates are relevant even at high volume centres Reinterventions
More informationConcentrations After a Pancreatoduodenectomy
Postprandial Plasma Gastrin and Secretin Concentrations After a Pancreatoduodenectomy A Comparison Between a PylorusPreserving Pancreatoduodenectomy and the Whipple Procedure TADAHIRO TAKADA, M.D., F.A.C.S.,
More informationPancreas Case Scenario #1
Pancreas Case Scenario #1 An 85 year old white female presented to her primary care physician with increasing abdominal pain. On 8/19 she had a CT scan of the abdomen and pelvis. This showed a 4.6 cm mass
More informationTHE ADVANCED SCIENCE JOURNAL
THE ADVANCED SCIENCE JOURNAL STRUCTURAL AND FUNCTIONAL SIGNS OF THE PANCREAS CONDITION DETERMINING THE TACTICS AND CHOICE OF THE METHOD OF OPERATION AT TREATING COMPLICATIONS OF ALCOHOLIC CHRONIC PANCREATITIS
More informationManagement of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas
CASE REPORT Management of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas Anand Patel, Louis Lambiase, Antonio Decarli, Ali Fazel Division of Gastroenterology
More informationImaging Techniques for Acute Necrotizing Pancreatitis: Multidetector Computed Tomography
AISP - 29 th National Congress. Bologna (Italy). September 15-17, 2005. Imaging Techniques for Acute Necrotizing Pancreatitis: Multidetector Computed Tomography Lucia Calculli 1, Raffaele Pezzilli 2, Riccardo
More informationStented Pancreatico-duodenectomy: Does it lead to decreased pancreatic fistula rates? A prospective randomized study
348 ORIGINAL ARTICLE Stented Pancreatico-duodenectomy: Does it lead to decreased pancreatic fistula rates? A prospective randomized study Sajida Qureshi, 1 Shahriyar Ghazanfar, 2 Roshane Rana, 3 Mohammad
More informationcombined right nephrectomy and pancreaticoduodenectomy Indications and Outcomes
ORIGINAL ARTICLE Combined Right Nephrectomy and Pancreaticoduodenectomy. Indications and Outcomes Mehrdad Nikfarjam 1, Niraj J Gusani 1, Eric T Kimchi 1, Rickhesvar P Mahraj 2, Kevin F Staveley-O Carroll
More informationSurgical Treatment for Carcinoma of the Ampulla of Vater and Residual Pancreatic Function before and after Pancreaticoduodenectomy*)
Hiroshima Journal of Medical Sciences Vol. 32, No. 4, 455,-...,460, December, 1983 HIJM 32-68 455 Surgical Treatment for Carcinoma of the Ampulla of Vater and Residual Pancreatic Function before and after
More information3/28/2012. Periampullary Tumors. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Eric K. Nakakura Ko Olina, HI
Overview Postgraduate Course in General Surgery Case presentation Differential diagnosis Diagnosis and therapy Outcomes Principles of palliative care Eric K. Nakakura Ko Olina, HI March 27, 2012 CASE 1:
More informationRe-Resection of isolated recurrent Pancreatic Cancer. Thilo Hackert May 31, 2013
Re-Resection of isolated recurrent Pancreatic Cancer Thilo Hackert May 31, 2013 PDAC Recurrence Surgical Topics follow-up after PDAC resection type of recurrence management - local - solitary metastasis
More informationPylorus preservation pancreatectomy or not
Review Article Pylorus preservation pancreatectomy or not Ulla Klaiber, Pascal Probst, Markus W. Büchler, Thilo Hackert Department of General, Visceral and Transplantation Surgery, University of Heidelberg,
More informationBiliodigestive anastomosis with circular mechanical device after pancreatoduodenectomy: our experience
Biliodigestive anastomosis with circular mechanical device after pancreatoduodenectomy: our experience Roberto Tersigni, Massimo Capaldi & Andrea Cortese Updates in Surgery Official Journal of the Italian
More informationHPB ORIGINAL ARTICLE. Abstract. Correspondence. Introduction
DOI:10.1111/hpb.12358 HPB ORIGINAL ARTICLE A case-matched comparison and meta-analysis comparing pylorus-resecting pancreaticoduodenectomy with pylorus-preserving pancreaticoduodenectomy for the incidence
More informationCitation American Journal of Surgery, 196(5)
NAOSITE: Nagasaki University's Ac Title Author(s) Multifocal branch-duct pancreatic i neoplasms Tajima, Yoshitsugu; Kuroki, Tamotsu Amane; Adachi, Tomohiko; Mishima, T Kanematsu, Takashi Citation American
More informationAppendix 9: Endoscopic Ultrasound in Gastroenterology
Appendix 9: Endoscopic Ultrasound in Gastroenterology This curriculum is intended for clinicians who perform endoscopic ultrasonography (EUS) in gastroenterology. It includes standards for theoretical
More informationRisk-Adapted Anastomosis for Partial Pancreaticoduodenectomy Reduces the Risk of Pancreatic Fistula: A Pilot Study
World J Surg (2010) 34:1579 1586 DOI 10.1007/s00268-010-0521-5 Risk-Adapted Anastomosis for Partial Pancreaticoduodenectomy Reduces the Risk of Pancreatic Fistula: A Pilot Study Marco Niedergethmann Niloufar
More informationVisceral aneurysm. Diagnosis and Interventions M.NEDEVSKA
Visceral aneurysm Diagnosis and Interventions M.NEDEVSKA History 1953 De Bakeyand Cooley Visceral aneurysm VAAs rare, reported incidence of 0.01 to 0.2% on routine autopsies. Clinically important Potentially
More informationSurgical anatomy of the pancreas for limited resection
J Hepatobiliary Pancreat Surg (2000) 7:473 479 Surgical anatomy of the pancreas for limited resection Wataru Kimura First Department of Surgery, Yamagata University School of Medicine, 2-2-2 Iida-Nishi,
More informationChronic Pancreatitis. Ara Sahakian, M.D. Assistant Professor of Medicine USC core lecture
Chronic Pancreatitis Ara Sahakian, M.D. Assistant Professor of Medicine USC core lecture What is Chronic Pancreatitis Progressive inflammatory disease Pancreatic parenchyma replaced w/fibrous tissue Destruction
More informationChronic Pancreatitis
Falk Symposium 161 October 12, 2007 Chronic Pancreatitis David C Whitcomb MD PhD Giant Eagle Foundation Professor of Cancer Genetics. Professor of Medicine, Cell biology & Physiology, and Human Genetics
More informationSurgical Workload, Outcome and Research Database: V1.1
Technical Guidance for Surgical Workload, Outcome and Research Database: V1.1 Contents 1. Standard Indicators... 5 1.1. Activity Volume... 5 1.2. Average Length of Stay (Days)... 5 1.3. 2/7/30 day Re-admission
More informationOutcomes associated with robotic approach to pancreatic resections
Short Communication (Management of Foregut Malignancies and Hepatobiliary Tract and Pancreas Malignancies) Outcomes associated with robotic approach to pancreatic resections Caitlin Takahashi 1, Ravi Shridhar
More informationClinical Study Pancreaticojejuno Anastomosis after Pancreaticoduodenectomy: Brief Pathophysiological Considerations for a Rational Surgical Choice
International Surgical Oncology Volume 2012, Article ID 636824, 4 pages doi:10.1155/2012/636824 Clinical Study Pancreaticojejuno Anastomosis after Pancreaticoduodenectomy: Brief Pathophysiological Considerations
More informationChronic pancreatitis an increasing Indian Problem
Chronic pancreatitis an increasing Indian Problem Dr Ramesh Ardhanari M.S; MCh.(SGE); FRCS (Hon)(G) Medical Director, Sr. Consultant & Head Dept. of Surgical Gastroenterology Meenakshi Mission Hospital,Madurai
More information