scholarly journals Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis

10.3791/60301 ◽  
2019 ◽  
Author(s):  
Alberto Balduzzi ◽  
Maurice J. W. Zwart ◽  
Rens M. A. Kempeneers ◽  
Marja A. Boermeester ◽  
Olivier R. Busch ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Lateral Pancreaticojejunostomy

Narcotic Independence After Pancreatic Duct Stenting Predicts Narcotic Independence After Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Pancreas ◽  
2016 ◽  
Vol 45 (8) ◽  
pp. 1126-1130 ◽  
Author(s):  
Richard S. Kwon ◽  
Benjamin E. Young ◽  
William F. Marsteller ◽  
Christopher Lawrence ◽  
Bechien U. Wu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Pancreatic Duct Stenting

scholarly journals Drainage procedures for small duct disease in chronic pancreatitis: a feasible option

2018 ◽  
Vol 5 (6) ◽  
pp. 2319
Author(s):  
Venkatarami Reddy Vutukuru ◽  
Raghavendra Rao R. V. ◽  
Varughese Mathai ◽  
Sarala Settipalli
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Intractable Pain ◽  
Disease Group ◽  
Preoperative Pain ◽  
Exocrine Insufficiency ◽  
Pain Scores ◽  
Small Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Feasible Option

Background: Surgery is the treatment of choice for intractable pain in chronic pancreatitis (CP). Drainage procedures are indicated in large duct disease whereas resectional procedures for small duct disease. Aim of this study was to assess prospectively the feasibility of drainage procedures in patients with CP with small duct disease.Methods: All consecutive patients with CP with small duct disease were included in the study. All patients underwent surgical intervention (lateral pancreaticojejunostomy with head coring). Primary outcome measures were pain relief and morbidity. These outcomes were compared with patients with CP with large duct disease.Results: 114 patients with CP underwent surgery. Of these 24(21.05%) patients had CP with small duct disease and 90(78.95%) patients had large duct disease. Demographic profile of the two groups was comparable. Mean pain scores were similar (47.75±6.85 versus 51.38±7.40; p = 0.14). Patients with large duct disease had higher incidence of diabetes mellitus (44.44% versus 8.33%; p = 0.02), but exocrine insufficiency was similar. All patients had calcifications in both the groups. Mean intraductal pressures measured intraoperatively were significantly high in patients with large duct disease (22.99±5.65 versus 18.33±3.52; p = 0.001). Frequency of complications at presentation were similar in both the groups (p = 0.29). Surgery relieved pain in 21/24 (87.5%) patients with small duct disease and 82/90 (91.11%) patients with large duct disease. Mean post-operative pain scores in small duct disease group (7.50±9.61 versus 51.38±7.40; p <0.001) and large duct disease group (5.14±7.88 versus 47.75±6.85; p <0.001) were significantly reduced when compared to preoperative pain scores. Incidence of postoperative complications was similar in both groups (16.66% versus 14.44%).Conclusions: Drainage procedures (lateral pancreaticojejunostomy with head coring) is a feasible for CP patients with small duct disease with good pain relief. 

scholarly journals Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection

2021 ◽  
Vol 12 (1) ◽  
pp. 47-51
Author(s):  
Kunal Sadanand Joshi ◽  
Sisir Bodepudi ◽  
Santhosh Kumar Ganapathi ◽  
Chandrasekar Murugesan ◽  
Jagan Balu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Distal Pancreatectomy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
The Body ◽  
Metastatic Spread ◽  
Pathological Examination ◽  
Jejunal Loop ◽  
En Bloc ◽  
Lateral Pancreaticojejunostomy

Abstract Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.

Robotic lateral pancreaticojejunostomy (Puestow procedure) performed for chronic pancreatitis

ASVIDE ◽  
2018 ◽  
Vol 5 ◽  
pp. 394-394
Author(s):  
Adeel S. Khan ◽  
Imran Siddiqui ◽  
Dionisios Vrochides ◽  
John B. Martinie
Keyword(s):  
Chronic Pancreatitis ◽  
Lateral Pancreaticojejunostomy ◽  
Puestow Procedure

The Effect of Malnutrition on Morbidity after Surgery for Chronic Pancreatitis

2005 ◽  
Vol 71 (6) ◽  
pp. 466-473 ◽  
Author(s):  
Thomas Schnelldorfer ◽  
David B. Adams
Keyword(s):  
Chronic Pancreatitis ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Protein Energy Malnutrition ◽  
Infectious Complications ◽  
Nutritional State ◽  
Nutritional Risk ◽  
Operative Morbidity ◽  
Lateral Pancreaticojejunostomy ◽  
Nutritional Risk Index

Protein-energy malnutrition is a notable problem in the management of patients with chronic pancreatitis. The effect of malnutrition on pancreatic surgery is not well known. The records of 313 consecutive patients who underwent lateral pancreaticojejunostomy (LPJ, n = 152), pancreaticoduodenectomy (PD, n = 78), or distal pancreatectomy (DP, n = 83) for chronic pancreatitis were retrospectively reviewed and analyzed. Subjective Global Assessment, Nutritional Risk Index, and Instant Nutritional Assessment were used to assess the nutritional state. An average of all three nutritional indexes was established, and patients were categorized into well nourished (n = 101) as well as mild (n = 91), moderate (n = 94), and severe malnourished (n = 27). Poor nutritional state was associated with an increase in postoperative complication rate (LPJ: well nourished 14%, mild 25%, moderate 31%*, severe 50%*; PD: well nourished 44%, mild 44%, moderate 60%, severe 88%*; DP: well nourished 17%, mild 13%, moderate 30%, severe 55%*; * P < 0.045 vs well nourished). Low serum albumin levels also increased operative morbidity. The increase in morbidity was reflected by a higher rate of infectious complications as well as increased ICU stay. Body mass index and weight loss did not contribute to change in outcome. Malnutrition was associated with a higher incidence of postoperative complications after surgery for chronic pancreatitis. An increase in operative morbidity might be related to decreased protein synthesis and impaired immunocompetence.

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