Chronic pancreatitis surgery: Difference between revisions
Jump to navigation
Jump to search
Iqra Qamar (talk | contribs) |
Iqra Qamar (talk | contribs) |
||
| Line 32: | Line 32: | ||
* Patients are usually managed with drainage procedure that may or may not be accompanied with limited resection. | * Patients are usually managed with drainage procedure that may or may not be accompanied with limited resection. | ||
==== 1.1 Lateral pancreaticojejunostomy ==== | ==== 1.1 Lateral pancreaticojejunostomy (LPJ): ==== | ||
* LPJ is the conventional surgical approach for pancreatic drainage. | |||
* The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage. | |||
==== 1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection ==== | ==== 1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection ==== | ||
Revision as of 15:38, 20 November 2017
|
Chronic pancreatitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
American Pancreatic Association Practice Guidelines |
|
Chronic pancreatitis surgery On the Web |
|
American Roentgen Ray Society Images of Chronic pancreatitis surgery |
|
Risk calculators and risk factors for Chronic pancreatitis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please help WikiDoc by adding more content here. It's easy! Click here to learn about editing.
Overview
Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.[1]
Surgery
| Chronic pancreatitis causing intractable abdominal pain | |||||||||||||||||||||||||||||||||||||||||
| Dilated pancreatic duct (>6-7mm) | Non dilated pancreatic duct (<6-7mm) | ||||||||||||||||||||||||||||||||||||||||
| Fibrosis in the head of pancreas Poor drainage | Head-dominant disease | Tail-dominant disease | Diffuse parenchymal involvement | ||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||
| Lateral pancreaticojejunostomy (Puestow procedure) | Lateral pancreaticojejunostomy with localized pancreatic head resection (Frey procedure) | Classic pancreaticoduodenectomy OR pylorus-preserving pancreaticoduodenectomy OR Duodenum-preserving pancreatic head resection (Beger procedure) | Distal pancreatectomy | Total pancreatectomy with islet autotransplantation | |||||||||||||||||||||||||||||||||||||
Surgery for the pain management:
- Surgery is usually considered when pain management fails with medical and endoscopic therapies.[2][3][4]
- The goals of surgery are:
- Effective pain relief
- To reduce morbidity
- To preserve long-term pancreatic function
1. Dilated pancreatic duct:
- Obstructive pancreatopathy is the underlying pathology in patients with dilated pancreatic duct.
- Patients are usually managed with drainage procedure that may or may not be accompanied with limited resection.
1.1 Lateral pancreaticojejunostomy (LPJ):
- LPJ is the conventional surgical approach for pancreatic drainage.
- The procedure involves connecting the pancreatic duct to a Roux-en-Y jejunal limb for drainage.
1.2 Lateral pancreaticojejunostomy with localized pancreatic head resection
2. Nondilated pancreatic duct:
2.1 Head-dominant disease
2.1.1 Pancreaticoduodenectomy
2.1.2 Duodenal-preserving pancreatic head resection
2.2 Tail-dominant disease
2.3 Diffuse parenchymal disease
Surgery for the management of complications:
1. Duodenal stenosis
2. Terminal biliary stenosis
3. Pancreatic pseudocysts
4. Gastric varices due to splenic vein occlusion
5. Fibrosing stenosis of the transverse colon
References
- ↑ Society for Surgery of the Alimentary Tract (SSAT) (2004). "Operative treatment for chronic pancreatitis". Retrieved 2007-06-09.
- ↑ Ammann RW, Muellhaupt B (1999). "The natural history of pain in alcoholic chronic pancreatitis". Gastroenterology. 116 (5): 1132–40. PMID 10220505.
- ↑ Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984). "Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients". Gastroenterology. 86 (5 Pt 1): 820–8. PMID 6706066.
- ↑ Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP (1994). "The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis". Gastroenterology. 107 (5): 1481–7. PMID 7926511.