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In a prospective clinical-experimental study, 15 patients with chronic pancreatitis operated consecutively due to severe pain were examined for the effects of a duodenum-preserving resection of the pancreas head on endocrine pancreas function. This was done by means of oral and intravenous glucose tolerance testing before the operation, on the 10th or 11th postoperative day, and three months after the operation. In addition to glucose levels in the peripheral venous blood, levels of insulin, C-peptide, glucagon, somatostatin, and pancreatic polypeptide were determined. As indicated by the k-value, glucose tolerance improved postoperatively in 11 patients; two patients showed no change, and one patient was worse. Only one patient developed evident diabetes mellitus immediately postoperatively. The pre- and postoperative levels of insulin and C-peptide showed no significant differences. The fasting levels of glucagon were significantly lower postoperatively than before the operation (2p less than 0.01). Duodenum-preserving pancreas head resection led to improvement of the glucose tolerance in the majority of patients; a deterioration was observed only in two cases.
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PMID:[The effect of duodenum-preserving pancreatic head resection on the endocrine pancreas function in patients with chronic head pancreatitis]. 134 82

Frey's duodenum-preserving resection is one of three techniques of conservative surgery for the relief of pain in chronic calcifying pancreatitis of the pancreatic head described since 1985 [2, 3, 7]. In our view Frey's procedure is the most satisfactory of the three techniques. It does not require transsection of the pancreas and is suitable to deal with ductal stenoses and stones not only in the pancreatic head but also in the body and tail of the pancreas. We have been impressed by the quality of pain relief obtained and by the smoothness of the postoperative course following this operation. Duodenum-preserving resection of the pancreatic head is greatly facilitated by the use of the ultrasonic dissector which permits dissection in a nearly bloodless field and is particularly suitable for achieving decompression of the intrapancreatic part of the common bile duct by dissecting anyway fibrosed and calcified tissue. The techniques of duodenum-preserving resection of the head of the pancreas are based on principles which have stood the test of time. They have, however, been introduced only a few years ago, and their role in the treatment of severe pain associated with chronic pancreatitis yet awaits more precise definition.
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PMID:[The Frey operation: a valuable enrichment of therapeutic possibilities of chronic calcifying pancreatitis]. 159 27

Duodenum-preserving resection of the head of the pancreas is a low-risk operation for patients with chronic pancreatitis. Subtotal resection of the head of the pancreas does not result in a significant diminishment in the exocrine and endocrine functions of the pancreas. Owing to the limited nature of the intervention, hospital and late mortality rates are low. More than 80% of the patients with CP have experienced long-lasting relief of pain after this procedure. In comparison with the Whipple operation duodenum-preserving resection of the head of the pancreas spares the patient a gastrectomy, a duodenectomy, and resection of the extrahepatic bile duct.
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PMID:Duodenum-preserving resection of the head of the pancreas--an alternative to Whipple's procedure in chronic pancreatitis. 169 3

Given an indication for surgery in patients with chronic pancreatitis, such as distal common bile duct obstruction, duodenal stenosis, or dilated pancreatic duct with stones and congestion, the surgeon must decide the type of operation to perform. A duodenopancreatectomy, the Whipple procedure, is widely considered to be the gold standard. It is highly effective in relieving pain and eliminating the structural abnormalities noted above. Duodenum-preserving resection of the head of the pancreas (DPRHP) seems to be an attractive alternative to pancreaticoduodenectomy (PD) in the treatment of chronic pancreatitis. In a clinical prospective randomized trial the efficiency of both operative methods was investigated. Between 7/1987 and 12/1993 43 patients were randomly assigned to undergo either a Whipple procedure (n = 21) or DPRHP (n = 22). Data on postoperative course, mortality, and postoperative morbidity were compiled. As concerns long-term results, postoperative hormonal status (insulin, neurotensin, cholecystokinin, gastrin) was checked, basal and stimulated with a standardized meal, using standard hormonal assay kits. All patients with PD survived, whereas one with DPRHP died from peritonitis. Patients with DPRHP had a significant more rapid convalescence (16.5 vs. 21.7 days). The range for postoperative follow-up is from 36 months to 5.5 years. In the DPRHP group 18 patients are in good condition. Two had diabetes and one developed carcinoma. In the PD group one died from hepatic coma, 14 are in good condition and 6 developed diabetes. All gained body weight with an average of 6.4 vs. 4.9 kg, DPRHP vs. PD. A difference between DPRHP and PD was obvious for the postoperative hormonal status. Results are satisfactory in both groups. For patients with DPRHP however, we see a quicker convalescence and a significant benefit as concerns postoperative hormonal status.
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PMID:[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]. 763 46

In a prospective clinical-experimental study, 15 consecutive patients with chronic pancreatitis, operated on because of severe pain, were examined for the effects of a duodenum-preserving resection of the pancreas head on endocrine pancreas function. This was done by means of oral and intravenous glucose tolerance testing before the operation, on the 10th or 11th day postoperatively, and 3 months after the operation. In addition to glucose levels in the peripheral venous blood, levels of insulin, C-peptide, glucagon, and pancreatic polypeptide were determined. As indicated by the k value, glucose tolerance improved postoperatively in 10 patients (66.6%); three patients (19.9%) showed no change, and one patient (6.6%) was worse. Only one patient (6.6%) developed evident diabetes mellitus immediately postoperatively. Pre- and postoperative levels of insulin and C-peptide showed no significant differences. The fasting levels of glucagon were significantly lower postoperatively than before the operation (p < 0.01). The stimulation of pancreatic polypeptide after oral glucose was significantly lower postoperatively (p < 0.01). Duodenum-preserving pancreas head resection does not lead to an impairment of glucose tolerance in the majority of patients; a deterioration was observed only in few cases (13.3%).
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PMID:Glucose homeostasis and endocrine pancreatic function in patients with chronic pancreatitis before and after surgical therapy. 810 71

Duodenum-preserving resection of the head of the pancreas was developed 25 years ago by Beger. This procedure is indicated in patients suffering from chronic pain in combination with inflammation of the head of the pancreas, common bile duct obstruction, pancreatic duct obstruction and/or obstruction of the retropancreatic vessels. At the Inselspital in Berne, 74 patients underwent this operation between 1993 and 1996. The median length of the operation was 380 min, with the need for transfusion in a median of 0 units (0-6). There was no postoperative mortality. Total postoperative morbidity was 13%. One patient needed relaparotomy on day 17 for small bowel obstruction. Median length of hospital stay was 11 days. Postoperatively, two patients developed diabetes. Duodenum-preserving resection of the head of the pancreas represents an organ-preserving principle of surgery. This procedure treats the complications of chronic pancreatitis and provides long-term pain relief in more than 80% of patients.
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PMID:[Duodenum preserving resection of the head of the pancreas: a standard procedure in chronic pancreatitis]. 920 30

In patients with chronic pancreatitis the inflammatory process in the pancreatic head is frequently the pacemaker of the disease. In these cases an inflammatory tumor develops which leads to local complications in half of the patients. Duodenum-preserving pancreatic head resection, contrary to procedures used in the past, offers the possibility to preserve stomach, duodenum, biliary tree, and the insulin secretory capacity. Duodenum-preserving pancreatic head resection is a subtotal resection of the pancreatic head. In a series of 380 patients the hospital mortality rate was 0.8%, the frequency of reoperation 5.3%, and the median hospitalisation time 13.9 days. The early postoperative glucose metabolism was deteriorated in 2% and improved in 9% of cases. After a median follow-up time of 6 years, 88% of the patients were completely painfree or suffered pain rarely. Sixty-three percent were gainfully employed; the late mortality was 8.9%. Only 10% of the patients had further bouts of pancreatitis. The decisive advantage of duodenum-preserving pancreatic head resection over Kausch-Whipple resection is preservation of the endocrine pancreatic function and of neighbouring organs.
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PMID:[Duodenum-preserving pancreatic head resection--a standard method in chronic pancreatitis]. 941 Jun 74

Duodenum-preserving pancreas resection for chronic pancreatitis results in a subtotal resection of the pancreatic head. Of 488 patients suffering from chronic pancreatitis with an inflammatory mass in the head, 48% had a common bile duct stenosis in the ERCP, 63% had a pancreatic main duct stenosis, 25% had a duodenum stenosis, and 17% showed vascular obstruction--mainly compression or occlusion of the portal vein. Hospital mortality after duodenum-preserving head resection was 0.9%. In the late follow-up, 88% of patients were free of pain and 60% were professionally rehabilitated. The incidence of diabetes mellitus in the late follow-up was 14%; however, 6% of the patients had a lasting improvement of endocrine function. Late mortality after a median follow-up of 6 years (1-22 years after surgical treatment) was 9%. Only 10% of the patients needed further hospitalization due to recurrent attacks of acute pancreatitis. Duodenum-preserving head resection should be the surgical procedure of choice in chronic pancreatitis with an inflammatory mass in the head of the pancreas and in cases with pancreas divisum after failure of medical and interventional treatment. Duodenum-preserving total pancreatectomy is a last-resort surgical treatment after failure of left resection for pain in chronic pancreatitis.
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PMID:The surgical management of chronic pancreatitis: duodenum-preserving pancreatectomy. 989 40

Chronic pancreatitis is a common disease with consumption of alcohol as a leading cause. It is characterized by an inflammatory mass usually located in the pancreatic head. The aim of treatment is mainly pain relief and improvement in the quality of life, which still poses a major challenge today. Duodenum preserving resections of the pancreas offer the best short-term outcome according to the trials conducted so far. It combines the highest safety of all effective surgical procedures with the highest efficacy; it might sound to be the one ideal operation for CP. In experienced centers the operative strategy might be modified slightly to suit the needs of the individual patient.
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PMID:Chronic pancreatitis--a surgeons' view. 1897 85

Pain relief and improvement in the quality of life are of paramount importance for any intervention in chronic pancreatitis. In several trial good results have been published after different drainage procedures and resections. An optimal surgical intervention should manage mainly the intractable pain, resolve the complications of the adjacent organs and achieve the drainage of the main pancreatic duct. An optimal procedure should guarantee a low relapse rate, preserve a maximum of endocrine and exocrine function, and most importantly, restore quality of life. Thus an ideal operation should representing a one-stop-shopping. According to the trials conducted so far, Duodenum-preserving resection of the pancreatic head offers the best short-term outcome. It combines the highest safety of all surgical procedures with the highest efficacy. By varying the extent of the cephalic resection, it offers the possibility of customizing surgery according to the individual patient's morphology.
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PMID:Surgical treatment in chronic pancreatitis timing and type of procedure. 2051 Aug 30


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