Incapacitating pain of chronic pancreatitis: a surgical perspective of what is known and what needs to be known
|
|
- Abner Lucas
- 6 years ago
- Views:
Transcription
1 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 of patients with established chronic pancreatitis, incapacitating, overwhelming, truly intractable pain develops that markedly alters quality of life and prevents ability to function productively in society (i.e., maintain employment or homemaking duties). Attempts to control the pain by pharmacologic means, such as oral pancreatic enzymes, nonnarcotic analgesics, psychopharmacologic agents, or celiac plexus blocks may prove untenable, leading to a vicious circle of ever-increasing needs for narcotic analgesics and the secondary physical and psychosocial problems of chemical addiction. Although the role of the surgeon is to treat the complications of chronic pancreatitis (i.e., hemorrhage; GI, biliary, or vascular obstruction; selected patients with pseudocyst disease; and severe pain), this article will focus specifically on surgical approaches in the patient with incapacitating, medically intractable pain from chronic pancreatitis. Three unique situations will be addressed: (1) small duct chronic pancreatitis (main pancreatic ductal diameter <5 mm), (2) large duct chronic pancreatitis (main duct diameter >7 mm), and (3) inflammatory mass in the head of the gland. Discussion will center on controversies in anatomic and nonanatomic parenchymal resections (pancreatectomy), ductal drainage/gland decompression procedures, and selective neurotomies (greater splanchnic neurotomy) or chemical neuroablative procedures (celiac plexus blocks). The outline will address what is known, what is not known, and our opinion about which studies are needed. From the Department of Surgery, Mayo Clinic, Rochester, Minnesota. Reprints not available from author. Gastrointest Endosc 1999;49:S85-9. Copyright 1999 by the American Society for Gastrointestinal Endoscopy /99/$ /0/95817 WHAT IS KNOWN (AND HOW GOOD IS THAT WHICH IS KNOWN ) In general, pancreatic surgeons have classically based their approach to the patient with chronic pain according to (1) the presence or absence of pancreatic ductal dilatation (large duct disease equated to duct drainage with pancreaticojejunostomy, whereas small duct disease required resection) and (2) the presence of an inflammatory mass in the head of the gland that necessitated resection (Table 1). As with many dictums in medicine, some of the classic dictums became subject to change as evidence-based medicine has developed. In general, until the last 5 to 10 years, most of the classic surgical series were retrospective or nonrandomized single institutional experiences (Table 2). For large duct disease management by the Partington- Rochelle (modified Puestow) procedure 1 led to good early results of 85% to 90% relief of pain. Reliable long-term results ( 5 years) are more difficult to come by, but those available suggest a falloff in success rates to ~60% to 70% maintenance of relief of pancreatic pain. Although not perfect, unlike major pancreatic resections, primary ductal drainage preserves pancreatic parenchyma and in theory serves to maintain whatever presurgical endocrineexocrine function existed; 1 group 2,3 has even maintained that ductal drainage may improve digestion and prevent further deterioration of pancreatic function. For small duct disease, results are more difficult to interpret (Table 2). In the pre-1985 era (data not shown in Table 2), surgical emphasis and thus the resective philosophy was based on the belief that the degree or amount of pancreatic pain was proportional to the amount of parenchyma involved. In general, distal subtotal resections were performed from the tail toward the head of the gland 60% to 80% to 95% resections. 4 These distal-based resections avoided the need for pancreaticoduodenectomy, which required duodenectomy and a biliaryenteric anastomosis, which in that era carried formidable operative morbidity and potential mortality. Although early results seemed encouraging, interest in left-to-right sided resections waned because of poor long-term results, not only in pain relief but also because of the resultant pancreatic exocrine and especially endocrine insufficiency induced surgically by the 80% to 95% resections; moreover, this patient population was often composed of noncompliant alcoholics. VOLUME 49, NO. 3, PART 2, 1999 GASTROINTESTINAL ENDOSCOPY S85
2 M Sarr, G Sakorafas Incapacitating pain of chronic pancreatitis: surgical perspective Table 1. Classical surgical approach to incapacitating pain of chronic pancreatitis Small duct disease Inflammatory mass in head of gland Ductal drainage Pancreatic resection (a) Pre-1985 era: distal pancreatectomy (60%-95%) (b) Post-1985 era: proximal pancreatectomy (pancreatoduodenectomy) Proximal pancreatectomy (a) Pancreatoduodenectomy (b) Nonanatomic duodenum-preserving head resection Table 2. Selected* surgical series of managing intractable pain of chronic pancreatitis Relief of pain Ductal anatomy/investigator Definition of pain relief Short-term ( 2 y) Long-term ( 5 y) Ductal drainage procedures 1974 Leger et al. 27 Good Brinton et al. 28 Good Bradley 29 Good to fair Mannell et al. 30 Relief Greenlee et al. 31 Complete or substantial 80 Small duct disease Parenchymal resection 1974 Leger et al. 27 Good or fair Frey et al. 32 Alive, working Rossi et al. 33 Complete improvement Stone et al. 6 Complete, partial but significant Howard and Zhang 34 Good to excellent Traverso and Kozarek 5 Pain free 76 Not available Ductal drainage 1974 Leger et al. 27 Good Delcore et al. 10 Completely free of pain 85 Not available 1998 Izbicki et al. 9 Complete relief of symptoms 90 Not available 1998 Rios et al. 8 Better 25 Not available Inflammatory mass in head of gland (resection) 1994 Frey and Amikura 18 Excellent Izbicki et al. 16 Pain free or infrequent episodes 95 Not available 1998 Buchler et al. 15 No pain or rare occurrence Not available *The authors apologize to those surgical investigators whose reported experience was not included in this table. Every attempt was made to give a broad overview of the field. The concept of the pacemaker of the pain of chronic pancreatitis residing in the head of the gland, generally attributed to Longmire at the University of California, Los Angeles, 5 stimulated interest in the post-1985 era in proximal pancreatectomy. Markedly improved operative mortalities of <5% after pancreatoduodenectomy, probably the result of improved support services and expanded experience with resections for malignancy, further encouraged the surgical focus to center on proximal resections. Short-term results (<2 years) were generally quite good with 70% to 80% significant relief of pain. Reports of long-term results (>5 years) are less common, but as with large duct disease, results generally fall off a bit to 50% to 70% success rates (Table 2). In an attempt to further increase success in this difficult population, several groups explored the use of total pancreatectomy, hoping that if all the pancreatic parenchyma was resected chronic pain would be relieved. 6,7 Unfortunately, results of total pancreatectomy were especially disappointing, not only in pain relief (only 40% to 80% relief) but also because of the obligate metabolic consequences of the apancreatic state. Readmissions for metabolic sequellae were all too common and frequently serious. 7 Recently, these groups have addressed an oftenasked, but never well-evaluated, question Will a primary duct drainage procedure lead to pain relief in small duct disease? Results were poor in one S86 GASTROINTESTINAL ENDOSCOPY VOLUME 49, NO. 3, PART 2, 1999
3 Incapacitating pain of chronic pancreatitis: surgical perspective M Sarr, G Sakorafas Table 3. Proposed studies to address appropriate management of intractable pain of chronic pancreatitis Anatomy Large and small duct disease (stratified) Small duct disease (without inflammatory mass in head of gland) Study groups for comparison Thoracoscopic splanchnicectomy Endoscopic chemical splanchnicectomy Pancreatic resection Pancreatoduodenectomy Duodenum-preserving, nonanatomic head resection Lateral pancreaticojejunostomy Proximal resection with or without drainage of distal remnant Drainage alone study 8 but appeared excellent in 2 other studies 9,10 ; a good explanation for such contrasting results remains unknown. The concept that the pain of chronic pancreatitis is a compartment syndrome 11 that requires unroofing of the restrictive pancreatic capsule has been used to justify this approach because intraparenchymal pressure is increased in these patients 12 and may exacerbate the changes observed in parenchymal nerves. 13 However, no good correlation was found between parenchymal pressure and pain score. 14 Nevertheless, successful results with a primary nonresectional ductal drainage and decompression procedure would be very attractive, especially in the patient with compensated but borderline pancreatic function. For patients with an inflammatory mass in the head of the gland (a small subset in the United States but apparently more frequent in Europe), proximal resection has been the procedure of choice with or without complete ductal drainage of the distal gland Results are similar to those of resection or drainage (~90% relief). A small but prospective randomized study by Izbicki et al. 15,16 suggests that the less-demanding nonanatomic resection, recently updated by Frey and Amikura, 18 is favored over the more technically difficult Beger resection. 15 Ductal drainage alone of a dilated pancreatic duct, in the presence of an inflammatory mass in the head of the gland, is technically impossible because the pancreatic duct courses posteriorly as it enters the head of the gland and requires a nonanatomic wedge-type resection of the overlying pancreatic parenchyma just to expose the duct. Criticism of the above-reported literature relates to the descriptive and often subjective nature of the definitions of success of pain relief (see Table 2, definition of pain relief). Attempts at a more objective evaluation of success with, for instance, prospectively designed visual analog scales of pain (see Lillemoe et al. 19 ) or validated quality-of-life instruments (see Izbicki et al., 9 Bloechle et al., 20 and Rios et al. 8 as examples) are largely lacking. In addition, burn out of disease would be expected to occur in some percentage (amount unknown) of the group with operation. 21 In the absence of controlled studies with patients without operations, the actual benefit of surgery remains uncertain. In addition to these criticisms, another confounding factor in evaluating success is the presence of chemical (narcotic) addiction in a large percentage of patients in most of these studies, making reliable evaluation of postoperative pain extremely difficult. Surgical denervation Recently, the explosion of minimally invasive surgical techniques has rekindled interest in surgical denervation of the pancreas. Because typical pancreatic pain is believed to be visceral (and not somatic) in origin and visceral pain should involve visceral afferent nerves (largely sympathetic in origin, i.e., the splanchnic nerves), several groups 22 have suggested use of minimally invasive thoracoscopic approaches to transection of the greater splanchnic nerve(s). Reported short-term results are almost unbelievably encouraging (~80% relief of pain) 23 ; however, again the above criticisms also apply to the majority of these studies long-term results are nonexistent and surgical memory of the extensive neurotomy applied to the pancreas in the past (see Wong et al.) 22 should be remembered as distinct failures for durable long-term relief of pain. WHAT IS NOT KNOWN Despite functionally 40 years of recent experience with pancreatic surgery for chronic pancreatitis, basic questions concerning selection of patients and therapeutic interventions remain. 1. What is the expected incidence of burn out (i.e., spontaneous regression of pain over 5 years)? 2. Does preoperative chemical (narcotic) dependence affect patient outcomes? 3. Is celiac plexus block with either a neurolyticneuroablative agent or steroids effective in relieving pain or avoiding operation? 4. Which is the best operation for large duct disease? 5. Which is the best operation for small duct dis ease? VOLUME 49, NO. 3, PART 2, 1999 GASTROINTESTINAL ENDOSCOPY S87
4 M Sarr, G Sakorafas Incapacitating pain of chronic pancreatitis: surgical perspective 6. Is a duodenum-preserving nonanatomic resection comparable to a formal pancreaticoduodenectomy? 7. Can pancreatic visceral pain be accurately differentiated from nonvisceral pain to thereby select patients for thoracoscopic splanchnic nerve transection? And what is the long-term (5-year) efficacy of this approach? POTENTIALLY IMPORTANT STUDIES With the above background in mind, what studies, if successfully designed and completed, would add important and clinically relevant information to the management of the persistent intractable pain of chronic pancreatitis? Three studies are proposed (Table 3), all of which would be markedly facilitated by a multicenter approach to maximize patient accrual as well as to allow a more universal acceptance of results across a more broad patient (and surgeon) population. The first proposed study is surgical neurotomy (thoracoscopic splanchnicectomy) versus chemical neural ablation (endoscopic celiac plexus block) versus pancreatic resection (pancreatoduodenectomy or duodenum-preserving head resection). This study could be applied to patients with large duct and small duct disease but stratified according to duct size ( 8 mm or <8 mm). This study would allow objective evaluation of efficacy of minimally invasive techniques of neuroablation that preserve the pancreatic parenchyma. Because a formal pancreatectomy in the presence of chronic pancreatitis is often difficult, there are other potentially important ramifications (social, economic) in addition to the concept of pain control. If a thoracoscopic approach is justified on the basis of positive results from this study, regionalization by referral to major centers with extensive experience with pancreatic resection, as seems warranted with pancreatic cancer, 24,25 might be avoided. The second proposed study is pancreatoduodenectomy (pylorus-preserving) versus a duodenumpreserving nonanatomic head resection versus drainage alone by pancreaticojejunostomy for small duct disease without an inflammatory mass in the head of the gland. Both the Frey and Beger procedures 15,18 were originally described for patients with inflammatory masses in the head region yet if the pacemaker of pain resides in the head region, a duodenum-preserving type of resection may prove equally successful, possibly by resecting the postganglionic nerve bundles to or from the celiac plexus. 26 Because the duodenum-preserving resections are less technically demanding, 18 referral to major centers may not be necessary if the resections are effective. Two recent studies 9,10 claiming good results with drainage alone for small duct are intriguing; if drainage (with its associated pancreatic parenchymal decompression ) provides equally good results, the threshold for suggestion of operative intervention in this group of patients may markedly (and rightfully so) decrease. The third proposed study is duct drainage alone versus proximal resection with ductal drainage of remnant (body/tail) for large duct disease. Although duct drainage provides reasonable success, pain recurs in at least 20% to 30% of patients by 5 years postoperatively. Would incorporating a resection of the pacemaker region (especially with the less demanding duodenum-preserving technique should it prove equivalent for formal anatomic resection) with a ductal drainage procedure help the subgroup that fails duct drainage alone? This study would markedly change the currently accepted approach of avoiding parenchymal resection whenever the duct is dilated and would add support to the recent report by Traverso and Kozarek 5 relating their results with pancreaticoduodenectomy for small or large duct disease. All these studies would require appropriate stratification of patient population according to the etiology of chronic pancreatitis (especially alcoholic versus nonalcoholic) and postsurgical abstinence from alcohol intake. Ideally, each study would include a control group without operation; however, in our opinion, the severity of preoperative symptoms probably precludes ethical inclusion of a noninterventional control group. How to deal with the presence of active preoperative chemical (narcotic) dependence will need to be addressed; ideally patients would undergo an intense preoperative attempt at detoxification with inpatient or well-controlled outpatient continuation of counseling for chemical dependence postoperatively. Criteria of success would require unambiguous objective scoring of intensity of chronic pain, incidence of episodic pain, and validated quality-of-life instruments. Criteria of success will require re-evaluation and follow-up at least 5 years postoperatively, not only with pain control but also with social rehabilitation. ACKNOWLEDGMENT We thank Deborah Frank for her assistance in the preparation of this manuscript. REFERENCES 1. Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 1960; 152: Nolan WA, Townsend CM Jr, Thompson JC. Operative drainage of the pancreatic duct delays functional impairment S88 GASTROINTESTINAL ENDOSCOPY VOLUME 49, NO. 3, PART 2, 1999
5 Incapacitating pain of chronic pancreatitis: surgical perspective M Sarr, G Sakorafas in patients with chronic pancreatitis: a prospective analysis. Ann Surg 1988;208: 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: Sawyer R, Frey CF. Is there still a role for distal pancreatectomy surgery for chronic pancreatitis? Am J Surg 1994;168: Traverso LW, Kozarek RA. Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Ann Surg 1997;226: Stone WM, Sarr MG, Nagorney DM, McIlrath DC. Chronic pancreatitis: results of Whipple resection and total pancreatectomy. Arch Surg 1988;123: Braasch JW, Vito L, Nugent FW. Total pancreatectomy for end-stage chronic pancreatitis. Ann Surg 1978;188: Rios GA, Adams DB, Yeoh K-G, Tarnasky PR, Cunningham JT, Hawes RH. Outcome of lateral pancreaticojejunostomy in the management of chronic pancreatitis with non-dilated pancreatic ducts. J Gastrointest Surg 1998;2: Izbicki JR, Bloechle C, Broerig DC, Kuechler T, Broelsch CE. Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure. Ann Surg 1998;227: 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: Karanjia ND, Widdison AL, Leung F, Alvarez C, Lutrin FJ, Reber HA. Compartment syndrome in experimental chronic obstructive pancreatitis: effect of decompressing the main pancreatic duct. Br J Surg 1994;81: Jalleh RP, Aslam M, Williamson RCN. Pancreatic tissue and ductal pressures in chronic pancreatitis. Br J Surg 1991;78: Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology 1988;94: Manes G, Buchler M, Pieramico O, Sebastiano PD, Malfertheiner P. Is increased pancreatic pressure related to pain in chronic pancreatitis. Int J Pancreatol 1994;15: Buchler MW, Freiss H, Bittner R, Roscher R, Krautzberger W, Muller MW, et al. Duodenum-preserving pancreatic head resection: long-term results. J Gastrointest Surg 1997;1: Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis: a prospective randomized trial. Ann Surg 1995;221: Buchler MW, Friess H, Muller 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: 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;220: Lillemoe KD, Cameron JL, Kaufman HS, Yeo CJ, Pitt HA, Sauter PK. Chemical splanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial. Ann Surg 1993;217: Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch CE. Quality of life in chronic pancreatitis results after duodenum-preserving resection of the head of the pancreas. Pancreas 1995;11: Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis: longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 1984;86: Wong GY, Sakorafas G, Tsiotos GG, Sarr MG. Palliation of pain in chronic pancreatitis: use of neural blocks and neurotomy. Surg Clin North Am. In press. 23. Bradley EL III, Reynhout JA, Peer GL. Thoracoscopic splanchnicectomy for small duct chronic pancreatitis: case selection by differential epidural anesthesia. J Gastrointest Surg 1998;2: Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222: Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221: Voshioka H, Wakabayashi T. Therapeutic neurotomy on head of pancreas for relief of pain due to chronic pancreatitis. Arch Surg 1958;46: Leger L, Lenriot JP, Lemaigri G. Five to twenty years followup after surgery for chronic pancreatitis in 148 patients. Ann Surg 1974;180: Brinton MH, Pellegrini CA, Stein SF, Way LW. Surgical treatment of chronic pancreatitis. Am J Surg 1984;148: Bradley EL III. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg 1987;153: Mannell A, Adson MA, McIlrath DC, Ilstrup DM. Surgical management of chronic pancreatitis: long-term results in 141 patients. Br J Surg 1988;75: Greenlee HB, Prinz RA, Aranha GV. Long-term results of sideto-side pancreaticojejunostomy. World J Surg 1990;14: Frey CF, Child CG III, Fry W. Pancreatectomy for chronic pancreatitis. Ann Surg 1976;184: Rossi RL, Rothschild J, Braasch JW, Munson JL, ReMine SG. Pancreatoduodenectomy in the management of chronic pancreatitis. Arch Surg 1987;122: Howard JM, Zhang Z. Pancreaticoduodenectomy (Whipple resection) in the treatment of chronic pancreatitis. World J Surg 1990;14: VOLUME 49, NO. 3, PART 2, 1999 GASTROINTESTINAL ENDOSCOPY S89
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 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 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 informationSurgical Management of Chronic Pancreatitis
George H. Sakorafas, M.D., George Peros 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, Athens, Greece INTRODUCTION Although initial management of patients with
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 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 informationBeger s operation and the Berne modification: origin and current results
J Hepatobiliary Pancreat Sci (21) 17:735 744 DOI 1.17/s534-9-179-2 TOPICS Chronic pancreatitis: current treatment strategies Beger s operation and the Berne modification: origin and current results André
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationTitle. region. Author(s) Citation Surgery, 145(3), pp ; Issue Date
NAOSITE: Nagasaki University's Ac Title Author(s) Huge pancreatic pseudocyst migratin region. Tajima, Yoshitsugu; Mishima, Takehi Taiichiro; Adachi, Tomohiko; Tsuneo Citation Surgery, 145(3), pp.341-342;
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 informationPANCREATITIS: MEDICAL AND TRANSPLANT CONSIDERATIONS, DHIRAJ YADAV, MD 1
DHIRAJ YADAV, MD 1 Good afternoon. This is actually an interesting time of the day to do pancreas topic since you just had lunch and this is the time when the pancreas is the most active with a lot of
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 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 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 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 informationThe Surgical Treatment of Chronic Pancreatitis: A Clinical Series of 17 Cases
Chirurgia (2013) 108: 794-799 No. 6, November - December Copyright Celsius The Surgical Treatment of Chronic Pancreatitis: A Clinical Series of 17 Cases D. Vasile, A. Ilco, D. Popa, A. Belega, S. Pana
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 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 informationDisclosures. Dr. Hall is a paid consultant to the American College of Surgeons (ACS) as Associate Director of ACS-NSQIP
Does Routine Drainage of the Operative Bed following Elective Distal Pancreatectomy reduce Complications? An Analysis of the ACS-NSQIP Pancreatectomy Demonstration Project Stephen W. Behrman, MD 1, Ben
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 informationH. G. Beger M. Buchler H. Ditschuneit P. Malfertheiner (Eds.) Research and Clinical Management
H. G. Beger M. Buchler H. Ditschuneit P. Malfertheiner (Eds.) Chronic Pancreatitis Research and Clinical Management With 246 Figures and 131 Tables Springer-Verlag Berlin Heidelberg New York London Paris
More informationPAPER. Experience With 208 Resections for Intraductal Papillary Mucinous Neoplasm of the Pancreas
PAPER Experience With 0 Resections for Intraductal Papillary Mucinous Neoplasm of the Pancreas Thomas Schnelldorfer, MD; Michael G. Sarr, MD; David M. Nagorney, MD; Lizhi Zhang, MD; Thomas C. Smyrk, MD;
More informationThe case against preoperative biliary drainage with pancreatic resection
HPB, 2006; 8: 426431 REVIEW ARTICLE The case against preoperative biliary drainage with pancreatic resection RURIK C. JOHNSON & STEVEN A. AHRENDT Department of Surgery, University of Pittsburgh Medical
More informationA Simple, Secure and Universal
HPB Surgery, 1997, Vol. 10, pp. 305-310 Reprints available directly from the publisher Photocopying permitted by license only (C) 1997 OPA (Overseas Publishers Association) Amsterdam B.V. Published in
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 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 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 informationThe Choice of Palliative Treatment for Biliary and Duodenal Obstruction in Patients With Unresectable Pancreatic Cancer: Is Surgery Bypass Better?
Int Surg 2016;101:58 63 DOI: 10.9738/INTSURG-D-14-00247.1 The Choice of Palliative Treatment for Biliary and Duodenal Obstruction in Patients With Unresectable Pancreatic Cancer: Is Surgery Bypass Better?
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 informationTHE CLINICAL course of severe
ORIGINAL ARTICLE Improved Prediction of Outcome in Patients With Severe Acute Pancreatitis by the APACHE II Score at 48 Hours After Hospital Admission Compared With the at Admission Arif A. Khan, MD; Dilip
More informationThe Influence of Pancreatic Ductal Anatomy on the Complications of Pancreatitis. William H. Nealon M.D.
The Influence of Pancreatic Ductal Anatomy on the Complications of Pancreatitis William H. Nealon M.D. Students and Trainees: Guide to Creativity, Productivity and Innovation in a Clinical Career Choose
More informationPAPER. What Prognostic Factors Are Important in Duodenal Adenocarcinoma?
PAPER What Prognostic Factors Are Important in Duodenal Adenocarcinoma? Faisal G. Bakaeen, MA, MB, BCh; Michel M. Murr, MD; Michael G. Sarr, MD; Geoffrey B. Thompson, MD; Michael B. Farnell, MD; David
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 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 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 informationChronic Pancreatitis
Supportive module 2: Basics of diagnosis, treatment and prevention of major gastroenterological diseases Chronic Pancreatitis LECTURE IN INTERNAL MEDICINE FOR IV COURSE STUDENTS M. Yabluchansky, L. Bogun,
More informationSurgical Management of Pancreatic Cancer
I Congresso de Oncologia D Or July 5-6, 2013 Surgical Management of Pancreatic Cancer Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD Estimated
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 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 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 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 informationThe Pancreas. Basic Anatomy. Endocrine pancreas. Exocrine pancreas. Pancreas vasculature. Islets of Langerhans. Acinar cells Ductal System
SGNA: Back to Basics Rogelio G. Silva, MD Assistant Clinical Professor of Medicine University of Illinois at Chicago Department of Medicine Division of Gastroenterology Advocate Christ Medical Center GI
More informationDistal Pancreatectomy with Celiac Axis Resection: What Are the Added Risks?
Distal Pancreatectomy with Celiac Axis Resection: What Are the Added Risks? Joal D. Beane, MD a, Michael G. House, MD a, Susan C. Pitt, MD c, E. Molly Kilbane a, Bruce L. Hall c, Abishek Parmar d, Taylor.
More informationReport of Three Cases of Chronic Pancreatic Fistulas Treated with Prolamine as a Sclerosing Substance Following Pancreatic Resection
ORIGINAL ARTICLE Report of Three Cases of Chronic Pancreatic Fistulas Treated with Prolamine as a Sclerosing Substance Following Pancreatic Resection Riccardo Casadei 1, Francesco Bassi 2, Lucia Calculli
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 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 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 informationSurgical. Gastroenterology. Evaluating the efficacy of tumor markers CA 19-9 and CEA to predict operability and survival in pancreatic malignancies
Tropical Gastroenterology 2010;31(3):190 194 Surgical Gastroenterology Evaluating the efficacy of tumor markers and CEA to predict operability and survival in pancreatic malignancies Jay Mehta, Ramkrishna
More informationMini-review on the glucose metabolism modifications after pancreatic resection TIMOFTE Daniel 1 *, IONESCU Lidia 1, OCHIUZ Lacramioara 1
International Letters of Natural Sciences Submitted: 2016-03-10 ISSN: 2300-9675, Vol. 53, pp 65-71 Revised: 2016-03-26 doi:10.18052/www.scipress.com/ilns.53.65 Accepted: 2016-03-28 2016 SciPress Ltd.,
More informationHPB INTERNATIONAL [2] Sung, J. J. Y., Chung, S. C. S., Yung, M. Y., Lai, C. W.,
HPB INTERNATIONAL 133 While the safety of endoscopic banding ligation is largely undisputed, there is one major risk of this technique: esophageal perforation during insertion of the overtube. Perforation
More informationThe mortality rate after major pancreatic and biliary surgery
ORIGINAL ARTICLES After Pancreatic and Biliary Surgery Embolization or Surgery? Steve M. M. de Castro, MD,* Koert F. D. Kuhlmann, MD,* Olivier R. C. Busch, MD,* Otto M. van Delden, MD, Johan S. Laméris,
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 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 informationSINCE THE classic description of. Decreasing Length of Stay After Pancreatoduodenectomy ORIGINAL ARTICLE
ORIGINAL ARTICLE Decreasing Length of Stay After Pancreatoduodenectomy Ari D. Brooks, MD; Stuart G. Marcus, MD; Catherine Gradek, MD; Elliot Newman, MD; Peter Shamamian, MD; Thomas H. Gouge, MD; H. Leon
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 informationSurgical management of chronic pancreatitis: Our institutional experience
Quest Journals Journal of Medical and Dental Science Research Volume 3~ Issue 1 (2016) pp:01-09 ISSN(Online) : 2394-076X ISSN (Print):2394-0751 www.questjournals.org Research Paper Surgical management
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 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 informationTreatment options in painful chronic pancreatitis: a systematic review
DOI:10.1111/hpb.12173 HPB REVIEW ARTICLE Treatment options in painful chronic pancreatitis: a systematic review Jan G. D'Haese, Güralp O. Ceyhan, Ihsan Ekin Demir, Elke Tieftrunk & Helmut Friess Department
More informationIs any surgical procedure ideal for chronic pancreatitis?
International Journal of Surgery (2007) 5, 45e56 www.theijs.com REVIEW Is any surgical procedure ideal for chronic pancreatitis? Nazir A. Wani, Fazl Q. Parray*, Mehmood A. Wani Department of Surgery, Sheri-Kashmir
More informationProf. (DR.) MD. ISMAIL PATWARY. MBBS, FCPS, MD, FACP, FRCP(Glasgow, Edin) Professor, Dept. of Medicine, Sylhet women s Medical College, Sylhet
Prof. (DR.) MD. ISMAIL PATWARY MBBS, FCPS, MD, FACP, FRCP(Glasgow, Edin) Professor, Dept. of Medicine, Sylhet women s Medical College, Sylhet CHRONIC PANCREATITIS Defined as a progressive inflammatory
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 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 informationReview article: pain and chronic pancreatitis
Alimentary Pharmacology & Therapeutics Review article: pain and chronic pancreatitis J.G.LIEBII&C.E.FORSMARK Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville,
More informationTotal pancreatectomy for chronic pancreatitis
Gut, 1988, 29, 358-365 Total pancreatectomy for chronic pancreatitis I P LINEHAN, M A LAMBERT, D C BROWN, A B KURTZ, P B COTTON, AND R C G RUSSELL From the Departments of Surgery, Gastroenterology and
More informationCan pancreaticoduodenectomy performed at a comprehensive community cancer center have comparable results as major tertiary center?
Journal of Gastrointestinal Oncology, Vol 2, No, September 20 4 Can pancreaticoduodenectomy performed at a comprehensive community cancer center have comparable results as major tertiary center? Charles
More informationLaparoscopic & Robotic Surgery in Pancreas Disease
2007 년도대한췌담도학회추계학술대회 Session IV: Recent Updates in Pancreatobiliary Diseases Laparoscopic & Robotic Surgery in Pancreas Disease Department of Surgery, Yonsei University College of Medicine, Korea Woo-Jung
More informationFAST TRACK MANAGEMENT OF PANCREATIC CANCER
FAST TRACK MANAGEMENT OF PANCREATIC CANCER Jawad Ahmad Consultant Hepatobiliary Surgeon University Hospital Coventry and Warwickshire NHS Trust Part 1. Fast Track Surgery for Pancreatic Cancer Part 2.
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,000 116,000 120M Open access books available International authors and editors Downloads Our
More informationPancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and prevention of long-term pancreatic complications
Zhang et al. BMC Gastroenterology (2018) 18:53 https://doi.org/10.1186/s12876-018-0777-z RESEARCH ARTICLE Pancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and
More informationClinical outcomes and nonendoscopic interventions after minor papilla endotherapy in patients with symptomatic pancreas divisum
ORIGINAL ARTICLE: Clinical Endoscopy Clinical outcomes and nonendoscopic interventions after minor papilla endotherapy in patients with symptomatic pancreas divisum Lyssa N. Chacko, MD, Yang K. Chen, MD,
More informationObjectives. Intraoperative Consultation of the Whipple Resection Specimen. Pancreas Anatomy. Pancreatic ductal carcinoma 11/10/2014
Intraoperative Consultation of the Whipple Resection Specimen Pathology Update Faculty of Medicine, University of Toronto November 15, 2014 John W. Wong, MD, FRCPC Department of Anatomical Pathology Sunnybrook
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 information6 th August 2018 Day 1 - Gallbladder & Bile duct Topic
Venue: Sterling Hospital Auditorium, Sterling Hospitals, Gurukul Road Ahmedabad, Gujarat 6 th August 2018 Day 1 - Gallbladder & Bile duct Registration(8:00am-8:15am) Inauguration(8:15am-8:30am) Welcome
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 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 informationORIGINAL ARTICLE. Howard M. Karpoff, MD; David S. Klimstra, MD; Murray F. Brennan, MD; Kevin C. Conlon, MD, MBA
ORIGINAL ARTICLE Results of Total Pancreatectomy for Adenocarcinoma of the Pancreas Howard M. Karpoff, MD; David S. Klimstra, MD; Murray F. Brennan, MD; Kevin C. Conlon, MD, MBA Hypothesis: Total pancreatectomy
More informationMaking ERCP Easy: Tips From A Master
Making ERCP Easy: Tips From A Master Raj J. Shah, M.D., FASGE Associate Professor of Medicine University of Colorado School of Medicine Co-Director, Endoscopy Director, Pancreaticobiliary Endoscopy Services
More informationEndoscopic Ultrasound-Guided Treatment of Pancreaticocutaneous Fistulas
ACG CASE REPORTS JOURNAL CASE REPORT ENDOSCOPY Endoscopic Ultrasound-Guided Treatment of Pancreaticocutaneous Fistulas Abdul Haseeb, MD, Barham K. Abu Dayyeh, MD, Michael J. Levy, MD, Larissa L. Fujii,
More informationPerspectives in Pancreatic Pain
HPB Surgery, 1997, Vol. 10, pp. 269-277 Reprints available directly from the publisher Photocopying permitted by license only (C) 1997 OPA (Overseas Publishers Association) Amsterdam B.V. Published in
More information