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 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The operation of total pancreatectomy is performed rarely. Its role in the management of patients with chronic pancreatitis remains to be elucidated. We have reviewed our series of 29 total pancreatectomies for benign disease [14 women median age 39 years; 15 men median age 34 years]. Twelve underwent standard total pancreatectomy, in 17 duodenum preserving total pancreatectomy (DPTP) was performed. There was one death (mortality 3.4%). In no patient was the total pancreatectomy the first operative procedure. The patients were compared with age and sex matched diabetic control subjects selected on a best fit basis from the diabetic clinic database. The aetiology of the pancreatitis was idiopathic nine, pancreas divisum nine, alcohol eight and other causes three. The indication for surgery was pain 27, acute pancreatitis one and cholangitis with pancreatitis one. The complications of the procedures were mainly caused by infection [wound three, chest six and central line sepsis four] and in two there was a leak from the duodenum; no patient required re-operation. The postoperative stay [standard total, median 21 days (range 13-98) DPTP median 31 days (range 17-49)] has lengthened over the period due to greater attention to analgesic, diabetic and enzyme deficiency control before discharge. In standard total pancreatectomy there were five major hypoglycaemic episodes with only two in 17 DPTP patients. The per cent ideal body weight, the insulin requirement and the HbAl compared less well in standard total pancreatectomy group compared with controls than did DPTP. With both groups large doses of enzyme replacement were required, and this proved of importance in diabetic control. Our experience with total pancreatectomy suggests that pain will be improved in over 80% of patients and that the results of surgery will improve with prolonged follow up provided attention is given to analgesic abuse, enzyme deficiency and diabetes.
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PMID:Total pancreatectomy for chronic pancreatitis. 335 68

A frequent complication (8.5 to 52.8%) of pancreatoduodenectomy (PD) for cancer, pancreatic fistula (PF) is difficult to treat, and an analysis of 30 cases of PD (27 for cancer, 3 for chronic pancreatitis) is used to determine risk factors and most effective therapy. Fistula developed in 6 cases (20%) and three risk factors were determined: preoperative renal impairment and hypoalbuminemia and ligature of pancreatic stump. Although not statistically significant, other factors--cancer, emergency surgery, fragile pancreatic tissue, thin Wirsung, pancreatojejunal anastomosis, absence of decompression of the raised jejunal loop--in this small series nevertheless provoked a marked increase in PF. One patient recovered after medical treatment, all five patients operated upon by whatever technique failing to survive. This agrees with literature data indicating heavy mortality (44.4 to 100%) after surgery. This should therefore be reserved for cases of PF failing to respond to adequate medical treatment, or with hemorrhage or intra-abdominal sepsis not controlled medically. The most effective therapy for PF is prophylactic, combining selection of patients as a function of risk factors, and treatment of pancreatic stump adapted to caliber of Wirsung and quality of remaining pancreatic tissue.
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PMID:[Pancreatic fistula following cephalic duodenopancreatectomy. Directed fistulization or total pancreatic exeresis?]. 337 2

The aim of our study was to determine the success of radical pancreatic resection in relieving the pain of chronic pancreatitis. From 1974 to 1985, 30 consecutive patients underwent radical pancreatic resection for the treatment of debilitating pain (15 underwent Whipple's resection and 15 underwent total pancreatectomy). Patients were not randomized but were subjected to the procedure deemed indicated for their clinical presentation; thus, the two groups were not strictly comparable. There was no operative mortality; major morbidity occurred in three patients (20%) in each group (four patients experienced anastomotic bile leak and two experienced abdominal sepsis). Following Whipple's resection, mean follow-up was 6.2 years (range, 1.5 to 12.1 years). Complete pain relief occurred in eight patients (53%) and significant relief in an additional four (27%). Endocrine insufficiency developed in six patients and exocrine insufficiency in eight. Following total pancreatectomy, mean follow-up was 9.1 years (range, 2.1 to 13.1 years). Complete pain relief occurred in only four patients (27%) and significant relief in an additional six (40%). Significant pain persisted in about 33% of patients after total pancreatic resection. We concluded that radical pancreatic resection can be performed safely in patients with chronic pancreatitis but with gratifying results in only 67% to 80% of patients. Whipple's resection may be preferable for disease located primarily in the head of the gland.
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PMID:Chronic pancreatitis. Results of Whipple's resection and total pancreatectomy. 338 46

Between the years of 1970 and 1984, a total of 96 patients underwent biliary enteric bypass to alleviate distal common bile duct obstruction from benign and all malignant disease. Cholecystoenterostomy (CCE) was performed in 13 patients (chronic pancreatitis 7, carcinoma 6), choledochoduodenostomy (CDD) was performed in 35 patients (stones 9, chronic pancreatitis 17, carcinoma 8, and fistula 1), cholecystojejunostomy (CDJ) was performed on 48 patients (stones 1, pancreatitis 21, carcinoma 25 and stricture 1). Operative mortality was 7 per cent and morbidity occurred in 12 per cent of the patients. Symptomatic improvement was measured by relief of pain and sepsis and decrease of bilirubin and alkaline phosphatase to normal. Overall improvement was seen in 73 per cent of patients (CCE 50%, CDD 8%, CDJ 65%), 27 per cent of the patients did not improve (CCE 50%, CDD 12%, CDJ 35%), 83 per cent of the poor results were in patients with advanced malignancy. Thirty-one per cent of patients undergoing CCE required conversion to CDD or CDJ. Cholecystoduodenostomy was associated with failure in 50 per cent of patients. CCD and CDJ are safe and reliable means of relieving distal common duct obstruction due to biliary or pancreatic disease. Cholecystojejunostomy may be performed in the terminal patient with advanced carcinoma requiring a short-term biliary bypass.
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PMID:Biliary enteric bypass for benign and malignant disease. 360 59

Six patients, ranging in age from 28 to 41 years, five men and one woman, underwent 80% to 95% pancreatectomy for chronic pancreatitis, with subsequent autotransplantation of pancreatic fragments. The technique for isolation of pancreatic fragments containing islets of Langerhans was extrapolated from previous experimental work. The follow-up period ranged from one to 25 months. Normal or near-normal carbohydrate metabolism was observed in each patient after the autotransplantation procedure; however, only two patients were insulin independent at 25 and 20 months. One patient died one month after pancreatectomy and autotransplantation of disseminated intravascular coagulation, and another died at three months of surgical complications and sepsis. The remaining two patients were alive and insulin dependent at nine and 25 months. Further developments in islet cell autotransplantation techniques are necessary to achieve, if possible, an insulin-independent status and avert surgically induced diabetes mellitus after total or subtotal pancreatectomy.
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PMID:Islet cell autotransplantation after subtotal pancreatectomy. 640 57

Total parenteral nutrition (TPN) was given to 121 patients admitted with severe pancreatitis (73), chronic pancreatitis (23), or pancreatic malignancy (25) over 104 months. No adverse effects on the pancreas were detected from the TPN, including the provision of intravenous (IV) fat. Nutritional status was maintained or improved in all groups, including patients undergoing surgical procedures and those experiencing marked stress. No significant impact on the clinical course of pancreatitis was observed, although the death rate in acute pancreatitis (15.2%) and complicated pancreatitis (18.5%) compares favorably with other published series where early surgical intervention was undertaken. There was an increased risk of catheter-related sepsis in patients with complicated pancreatitis (14.8%) and with chronic pancreatitis (17.4%). No increase septic risk was seen in patients with acute pancreatitis or pancreatic malignancy. Eighty-two per cent of patients with acute pancreatitis required an average of 87 units of insulin per day while 78% of patients with chronic pancreatitis required an average of 54 units per day. In summary, TPN proved to be safe, effective, and well-tolerated in those patients with disorders of the pancreas.
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PMID:Total parenteral nutrition in pancreatic disease. 643 52

A syndrome of distal common bile duct obstruction secondary to the fibrotic effects of chronic pancreatitis has been recognized for some time. A group of ten characteristic patients, seven of whom have undergone surgery, is discussed. The diagnostic techniques and surgical procedures are presented, and the results are analyzed. Three patients with the syndrome were not operated upon and one improved spontaneously. The typical patient was a male alcoholic, average age 48 years, with a history of chronic, relapsing pancreatitis and abdominal pain. The most consistently abnormal laboratory value is a markedly elevated alkaline phosphates level. Endoscopic retrograde pancreaticocholangiography and transhepatic cholangiography are the most useful diagnostic procedures. Fifteen per cent of the most useful diagnostic procedures. Fifteen per cent of the patients operated upon required emergent surgery for acute cholangitis and sepsis. Another 29 per cent required prompt intervention for progressive hepatic failure secondary to biliary cirrhosis. The authors advocate an aggressive approach to establish biliary drainage in the presence of acute cholangitis or biliary cirrhosis. If a dilated pancreatic duct can be demonstrated and abdominal pain is the principal problem a direct procedure on the pancreas is needed.
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PMID:Biliary obstruction in chronic pancreatitis: indications for surgical intervention. 724 5

Six of seven patients with acute pancreatitis who were intractable to prolonged medical therapy underwent successful endoscopic retrograde cholangiopancreatography (ERCP) followed by immediate operative therapy. All of these patients had surgically correctable lesions consistent with chronic pancreatitis. There was one associated mortality and no morbidity. The conditions of the surviving six patients were significantly improved in the immediate postoperative period, and long-term follow-up has been encouraging. Pancreaticojejunostomy and conservative resection appeared to have good results. The timing of the operation immediately after ERCP in patients with acute pancreatic pathology eliminated problems with exacerbation or sepsis. Patients whose clinical conditions do not improve with aggressive medical therapy for acute pancreatitis may have both chronic and acute disease that is amenable to operative therapy.
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PMID:Acute and subacute pancreatitis. Role of surgery and endoscopic retrograde cholangiopancreatography. 736 68

A randomized double-blind placebo-controlled multicentre trial was carried out in 247 patients undergoing major elective surgery for chronic pancreatitis to clarify whether the perioperative application of octreotide prevents postoperative complications. Eleven complications were defined, including death, anastomotic leakage, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency and postoperative pancreatitis. A total of 124 patients underwent pancreatic head resection, 55 left resection, 61 pancreaticojejunostomy and seven had other procedures. The overall mortality rate was 1.2 per cent (octreotide group 1.6 per cent, placebo group 0.8 per cent [corrected] (P not significant)). The postoperative complication rate in the octreotide group was 16.4 per cent (20 of 122 patients) and in the placebo group 29.6 per cent (37 of 125) (P < 0.007). The perioperative application of octreotide substantially reduces the risk of postoperative complications in patients undergoing major pancreatic surgery for chronic pancreatitis.
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PMID:Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. 866 15

A novel method of pancreatic anastomosis after proximal Whipple-type resection: classical pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD), has been evaluated over a 5-year period from 1987 to 1992 in 52 patients. Indications for resection included chronic pancreatitis (n = 9) and neoplasms (n = 43). Reconstruction involved a cephalad end-to-end duodeno-/gastro-jejunal anastomosis with a biliary anastomosis 6-8 cm downstream. A separate isolated defunctioned Roux loop was used to construct a duct-to-mucosa (Wirsung-jejunal) pancreaticojejunostomy. Median postoperative stay was 18.0 days (range 11-32 days); three deaths (operative mortality 5.8%) occurred due to sepsis (subhepatic abscess), profound hypoglycaemia and necrotising pancreatitis respectively. These deaths were not related to pancreatic fistula. There were no pancreatic leaks (defined as greater than 50 ml of amylase-rich fluid for more than 7 days). Postoperative exocrine pancreatic function was good as assessed by re-establishment of preoperative weight (achieved in 35 of 40, ie 88% of surviving PPPD patients), clinical steatorrhoea (present in 10 of 41, ie 24% of surviving patients resected for neoplasm), and the need for pancreatic exocrine supplements (required in only 4 of 41, ie 9.8% of surviving patients resected for neoplasm). Twenty patients considered to have normal pancreatic remnants underwent a p-aminobenzoic acid (PABA) excretion test at 3 to 18 months after operation. Median PABA excretion index was 48% (range 24-100%). Isolated defunctioned duct-to-mucosa pancreaticojejunostomy is a safe procedure offering good functional results after Whipple's PD or PPPD resection.
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PMID:Safety and function of isolated Roux loop pancreaticojejunostomy after Whipple's pancreaticoduodenectomy. 791 89


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