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Satyajit Rath, Susanta Meher, Abhimanyu Basu, Sujata Priyadarshini, Bikram Rout, Rakesh Sharma
INTRODUCTION: Chronic pancreatitis is a debilitating disease, associated with excruciating abdominal pain, exocrine and endocrine pancreatic insufficiency. Different types of surgical techniques have been described for the management of complications of this disease. The most common procedure which has been adopted for improving the quality of life of the patients with chronic pancreatitis is Frey's Procedure. It is an organ preserving procedure in which the main pancreatic duct is drained by lateral pancreatico-jejunostomy along with coring of the head of the pancreas...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Adarsh Vijay, Islam Noaman, Ahmed Mahfouz, Mahwish Khawar, Hatem Khalaf, Ahmed Elaffandi
INTRODUCTION: Pancreatic fistula remains the main cause for postoperative morbidity following pancreaticoduodenectomy. The coincidence of sentinel bleed prior to post pancreatectomy haemorrhage (PPH) and pancreatic fistula is associated with very high mortality. PRESENTATION OF CASE: We report a case of pancreaticoduodenectomy complicated by postoperative leak and hematemesis. Severe delayed haemorrhage from the pancreatico-jejunostomy necessitated re-laparotomy and complete disconnection of the pancreatic anastomosis...
2016: International Journal of Surgery Case Reports
Christopher M Halloran, Kellie Platt, Abbie Gerard, Fotis Polydoros, Derek A O'Reilly, Dhanwant Gomez, Andrew Smith, John P Neoptolemos, Zahir Soonwalla, Mark Taylor, Jane M Blazeby, Paula Ghaneh
BACKGROUND: Failure of the pancreatic remnant anastomosis to heal following pancreato-duodenectomy is a major cause of significant and life-threatening complications, notably a post-operative pancreatic fistula. Recently, non-randomized trials have shown superiority of a most intuitive anastomosis (Blumgart technique), which involves both a duct-to-mucosa and a full-thickness pancreatic "U" stitch, in effect a mattress stitch, over a standard duct-mucosa technique (Cattell-Warren). The aim of this study is to examine if these findings remain within a randomized setting...
2016: Trials
Hitomi Kamo, Seiki Tashiro, Kazuo Yoshioka, Yuko Sumise, Natsu Okitsu, Yukari Harino, Takeshi Yamaguchi, Shizuo Ikeyama, Akemi Yamanaka
PURPOSES: Pancreatoduodenectomy (PD) was performed for 6 periampullary cancer patients by using methods verified by quality randomized controlled trials (RCT) in a low-volume center (LVC). The purpose of this study was to verify the clinical results. METHODS: No-touch pylorus-resecting pancreatoduodenectomy (PrPD), antecolic gastrojejunostomy, pancreatico-jejunostomy with a lost stent tube to the main pancreatic duct, and early removal of a prophylactic drain were performed...
2015: Journal of Medical Investigation: JMI
Shun-Jun Fu, Shun-Li Shen, Shao-Qiang Li, Wen-Jie Hu, Yun-Peng Hua, Ming Kuang, Li-Jian Liang, Bao-Gang Peng
BACKGROUND: Pancreatic fistula (PF) remains the most challenging complication after pancreaticoduodenectomy (PD). The purpose of this study was to identify the risk factors of PF and delineate its impact on patient outcomes. METHODS: We retrospectively reviewed clinical data of 532 patients who underwent PD and divided them into PF group and no PF group. Risk factors and outcomes of PF following PD were examined. RESULTS: PF was found in 65 (12...
2015: BMC Surgery
P S Aravinda, Sudipta Saha, Manoj Andley, O P Pathania, Ajay Kumar
Isolated pancreatic laceration is a rare injury. The typical mechanism by which it occurs is overstretching of the pancreas across the vertebral column during blunt abdominal trauma. The management depends on the location and extent of the injury. Disruption of the pancreatic duct usually requires operative treatment. Operative options for pancreatic laceration at the neck include distal pancreatectomy or suturing of the cephalic remnant and Roux-en-Y pancreatico-jejunostomy on the left remnant. We are reporting two cases of isolated pancreatic injury with disruption of the pancreatic duct but preserved posterior surface of the pancreas...
January 2014: Journal of Surgical Technique and Case Report
Jad Abou Khalil, Nancy Mayo, Sinziana Dumitra, Mohammed Jamal, Prosanto Chaudhury, Peter Metrakos, Jeffrey Barkun
BACKGROUND: A pancreatic fistula (PF) is a major contributor to morbidity and mortality after a pancreaticoduodenectomy (PD). There remains debate as to whether re-establishing pancreaticoenteric continuity by a pancreatico-gastrostomy (PG) can decrease the risk of a PF and complications compared with a pancreatico-jejunostomy (PJ). The outcomes of patients undergoing these reconstructions after a PD were compared. METHOD: Patients undergoing a PD between 1999 and 2011 were selected from a prospective database and having undergone either a PG or PJ reconstruction...
December 2014: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Daisuke Hashimoto, Masahiko Hirota, Akira Chikamoto, Toru Beppu, Hideo Baba
BACKGROUND/AIMS: Post-operative leakage from pancreatic anastomosis remains an important cause of morbidity in pancreaticoduodenectomy. It also contributes to prolonged hospitalization and mortality. We have developed a new inserting end-to -side pancreatico-jejunostomy without stiches on the pancreatic cut end or pancreatic duct. METHODOLOGY: In this novel anastomosis technique, the pancreatic stump is first sunk into jejunum deeply in an end-to-side manner and tightened with a purse string in the bowel serosa...
March 2014: Hepato-gastroenterology
Salah Binziad, Ahmed A S Salem, Gamal Amira, Farouk Mourad, Ahmed K Ibrahim, Tariq Mohamed Abdel Manim
BACKGROUND: Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. MATERIALS AND METHODS: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3...
July 2013: South Asian Journal of Cancer
D Vasile, A Ilco, D Popa, A Belega, S Pana
INTRODUCTION: Despite the fact that in the last few years, new invasive non-surgical therapies were introduced, surgical treatment of chronic pancreatitis still plays an important part.The aim of the study is to evaluate pain remission and quality of life after surgical approach. MATERIAL AND METHOD: We present 17 cases of chronic pancreatitis that were operated between 2007-2011. Surgical treatment was decided for after the failure of pain control therapy (14 cases)and by the suspicion of cancer in the head of the pancreas (3 cases)...
November 2013: Chirurgia
Munazza Anis, Koenraad Mortele
OBJECTIVE: This study was conducted to assess the role of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in the evaluation of patients following pancreatico-jejunal anatomosis. MATERIALS AND METHODS: S-MRCP studies (n = 83) performed at Brigham and Women's Hospital between 1/2005 and 7/2005 were retrospectively reviewed. Among these, there were 13 patients (10 females, 3 males; mean age = 45 years, range = 18-74 years) who were evaluated with S-MRCP following pancreatojejunal anatomosis...
2013: Journal of Clinical Imaging Science
R Grützmann, M Distler, T Keck, M Niedergethmann
INTRODUCTION: The pancreatic anastomosis seems to be the most difficult and dangerous anastomosis in general surgery, especially in a soft pancreas. Many techniques have been described. The techniques most often used are: anastomosis of the pancreas to the jejunum as a pancreatico-jejunostomy (duct-to-mucosa anastomosis) or as a pancreato-jejunostomy (invaginating anastomosis). Another widely used anastomosis for reconstruction after pancreatic head resection is from the stomach to the pancreas, i...
February 2013: Zentralblatt Für Chirurgie
M Cavallini, M La Torre, M Ferri, V Vitale, P Mercantini, M Dente, V Ziparo
AIM: Pancreatic fistula (PF) represents the main complication (10%-29%) after pancreatic surgery. Soft pancreatic texture with a not dilated pancreatic duct represent the major risk factors for PF. Mortality after pancreaticoduodenectomy (PD) is reported in several large series to be <5%. PF and local sepsis are the main causes of delayed arterial hemorrage with a high mortality rate (14-38%). Therefore, any effort should be implemented in order to reduce the incidence of PF. METHODS: In the present study we have extended the use of the biological adhesive Bioglue® to coat pancreatic resection surface after distal pancreasectomy (DP, N...
October 2012: Minerva Chirurgica
Pedro J Ríos, Eduardo Montoya, Cesar Romero
This case is about a one obesity patient to carry out pancreaticoduodenectomy for solido pseudopapilary cyst of the pancreatic head, considerate in pancreatic surgery like high risk for to present soft pancreatic, wirsung smaller to 2mm and not bile duct dilatation .The pancreaticojejunostomy was performed end to end with invagination of the pancreatic stump with suture in tobacco bag to a defunctionalized jejunal loop Y the Roux to avoid middle alkali of the bile duct - jejunostomy.
July 2012: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
Mehdi Ouaïssi, Urs Giger, Guillaume Louis, Igor Sielezneff, Olivier Farges, Bernard Sastre
Complete surgical resection still remains the only possibility of curing pancreatic cancer, however, only 10% of patients undergo curative surgery. Pancreatic resection currently remains the only method of curing patients, and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected cancer. Pancreatic surgery is a technically demanding procedure requiring highly standardized surgical techniques. Nevertheless, even in experienced hands, perioperative morbidity rates (delayed gastric emptying, pancreatic fistula etc...
June 28, 2012: World Journal of Gastroenterology: WJG
Vishal Gupta, Abhijit Chandra
BACKGROUND: While hepatic artery pseudoaneurysm is an uncommon complication of the chronic pancreatitis, celiac axis stenosis has rarely been reported in chronic pancreatitis. Although both of these entities have been reported in isolation, simultaneous occurrence of these two problems in one patient of chronic pancreatitis has not been reported so far. METHODS: A 32-year-old nonalcoholic male presented with hematemesis and melena for one month. He had undergone longitudinal pancreatico-jejunostomy for the idiopathic chronic pancreatitis one year back...
February 2013: Clinics and Research in Hepatology and Gastroenterology
I Popescu, T Dumitraşcu
Pancreatico-duodenectomy represents one of the most important and complex surgical digestive procedure. Although rarely performed in the past, nowadays has become a routine surgery. Moreover, postoperative mortality significantly decreased (from over 30% to less than 5%), while the number of severe, life-threatening complications were reduced. This outcome was possible due to technical innovations acquired in time, and also due to a better per operative management of these patients, in tertiary surgical centers, with experienced operative teams...
May 2011: Chirurgia
T Wehrmann
BACKGROUND AND STUDY AIMS: Sphincter of Oddi dysfunction (SOD) is one important cause of idiopathic acute-recurrent pancreatitis (ARP). Several trials have documented complete remission from ARP after endoscopic sphincterotomy during a 2-3-year follow-up. Data with longer follow-up, however, are not available. PATIENTS AND METHODS: Between 1995 and 1998, endoscopic sphincterotomy was performed in 37 patients with manometrically documented SOD and ARP. Afterwards, all patients were prospectively re-evaluated over a period of at least 2 years...
March 2011: Endoscopy
Aram N Demirjian, Tara S Kent, Mark P Callery, Charles M Vollmer
BACKGROUND: Pancreatico-jejunostomy strictures (PJS) after pancreatiocoduodenectomy (PD) are poorly understood. METHODS: Patients treated for PJS were identified from all PDs (n = 357) performed for all indications in our practice (2002 to 2009). Technical aspects of the original operation, as well as the presentation, management and outcomes of the resultant stricture were assessed. RESULTS: Seven patients developed a symptomatic PJS for an incidence of 2%...
September 2010: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
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