DOCSLIB.ORG

Classic Diseases Revisited Chronic Pancreatitis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Postgrad Med J 1996; 72: 327 - 333 (© The Fellowship of Postgraduate Medicine, 1996 Classic diseases revisited Postgrad Med J: first published as 10.1136/pgmj.72.848.327 on 1 June 1996. Downloaded from Chronic pancreatitis: diagnosis and treatment Summary Three-dimensional magnetic reson- ance cholangiopancreatography is Sandeep Sidhu, Rakesh K Tandon currently the most exciting new ima- ging technique for chronic pancrea- titis. Endoscopy-assisted duodenal intubation during the secretin-cho- Chronic pancreatitis is prevalent in most parts of the world although its lecystokinin test reduces intubation aetiology and clinical course may vary in different regions. Community-based time in difficult cases. The NBT- field studies from our centre have revealed that tropical chronic pancreatitis in para-amino benzoic acid test has Southern India is a mild disease with onset of symptoms in early adulthood,' been refined to enhance its discri- and a prevalence of 1:793 in endemic areas. The predominant symptoms are minant power. The cholesteryl- abdominal pain (30.6%), diabetes mellitus (52.8%) and malabsorption [C13]octanoate breath test and the (16.7%).' On the other hand, patients presenting to office practice,2 or to local faecal elastase test are newer highly or tertiary care hospitals3 have severe chronic pancreatitis, with abdominal pain sensitive and specific tubeless tests. as the predominant symptom (approximately 80%); exocrine pancreatic Pain in chronic pancreatitis con- insufficiency and calcification are seen in 80 - 90% patients.2 In a recent tinues to be a vexing therapeutic study,3 surgical treatment for pain was required in 53.9% of chronic pancreatitis issue. Enzyme treatment continues patients referred to the All India Institute ofMedical Sciences, a leading tertiary despite criticism. Neurotensin is the care centre in Northern India. new suspected mediator ofthe feed- Chronic pancreatitis is incurable except in some specific situations such as back mechanism, which is down- hyperparathyroidism where cure can be expected with surgical removal of the regulated by enzyme therapy. Ster- parathyroid glands. Alcohol withdrawal may slow down, but not reverse the oid ganglion block is an exciting progressive damage to the pancreas. Nevertheless, rapidly advancing knowledge therapeutic tool for pain relief. of the pathogenesis of chronic pancreatitis now allows us to adopt a Endoscopic pancreatic sphinctero- multidimensional strategy for its management. Therepeutic strategies in tomy, Dormia basketing and pan- chronic are discussed below with on recent creatic stenting in conjunction with pancreatitis (box 1) emphasis extracorporeal shock wave litho- developments in diagnosis and treatment. tripsy should be performed early in chronic pancreatitis to prevent par- Diagnosis enchymal atrophy with ensuing exo- crine and endocrine pancreatic CONVENTIONAL PANCREATIC IMAGING dysfunction. The modified Pues- Plain film of the abdomen for pancreatic calcification, sonography, tow's procedure preserves endo- computed tomography (CT) and endoscopic retrograde cholangiopancreato- http://pmj.bmj.com/ crine and exocrine pancreatic graphy (ERCP) remain the mainstay of diagnosis of chronic pancreatitis. functions besides relieving pain. Recently, on comparing 1.5-T magnetic resonance imaging (MRI) with Closed loop insulin infusion allows dynamic gadolinium enhancement, with CT and ERCP, Semelka et al4 superior management of pancreatic found MRI scanning to be most sensitive and specific in detecting diabetes following near total pancreatic diseases. pancreatectomy. The standardised incidence rate of pancreatic cancer MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) is 16.5 in patients with alcoholic MRI is utilised in this latest and most exciting technique to visualise the on September 27, 2021 by guest. Protected copyright. chronic pancreatitis and 100 pancreatic and biliary ductal systems. It is bound to have a significant impact on for tropical chronic pancreatitis. the diagnosis and management of biliary and pancreatic diseases.5 Important Aggressive treatment protocols features of the technique are summarised in box 2. combining neo-adjuvant chemora- MRCP offers a precise, diation and intra-operative radia- noninvasive, three-dimensional coronal and frontal tion with surgery are being used to display of pancreatic and biliary ductal systems. improve the prognosis in this dismal complication of chronic pancreati- SERUM LEVELS OF PANCREATIC ENZYMES tis. Depressed serum levels of pancreatic isoamylase, lipase, and pancreatic polypeptide aid in the diagnosis of chronic pancreatitis. Elastase, deoxyribo- Keywords: pancreatitis, pancreatic cancer, nuclease and ribonuclease are elevated, along with an increased trypsin/ pancreatic function, pain creatinine clearance ratio.6 LACTOFERRIN ASSAY Elevated levels of lactoferrin in the pure pancreatic juice and an increased lactoferrin to lipase ratio in duodenal juice following secretin - Department of Gastroenterology, All cerulein India Institute of Medical Sciences, stimulation7 have been claimed to be very sensitive and specific for detecting New Delhi 110029, India early chronic pancreatitis. S Sidhu RK Tandon PANCREATIC ENZYME SYNTHESIS Demonstration of an increased rate of pancreatic enzyme synthesis using Correspondence to Professor RK Tandon radiolabelled amino acids is another highly sensitive index of early chronic Accepted 16 October 1995 pancreatitis.8 328 Sidhu, Tandon PANCREATIC FUNCTION TESTS (BOX 3) Chronic pancreatitis: The secretin- cholecystokinin stimulation test with duodenal intubation therapeutic strategies standard for diagnosing chronic pancreatitis. Recently, remains the gold Postgrad Med J: first published as 10.1136/pgmj.72.848.327 on 1 June 1996. Downloaded from * symptomatic relief of pain Madrazo-de la Garza et al' reduced the length of the study from 150 to 45 * management of exocrine and minutes by aspirating duodenal fluid through a fibre-optic endoscope. Since endocrine insufficiency endoscopy is costly and adds to the discomfort, Dimagno et al' have suggested * therapeutic interception of the use of endoscopy only during intubation difficulties. In the latter situation pathophysiology they would endoscope patients, place a guidewire in the duodenum, withdraw * management of complications the endoscope, slide the aspiration tube over the wire and then perform the test as usual. This reduces the intubation time and also the frequency ofperforming Box 1 endoscopy to test the pancreatic functions. The Lundh test meal continues to be performed in several centres as a cheap and effective alternative to the secretin test while recognising its relative insensitivity in early chronic pancreatitis."1 Tubeless tests such as the NBT- para-aminobenzoic acid (PABA) test and pancreolauryl test'2-'4 are easy to perform and convenient to the patients, although the kits are not easily available and are expensive. Moreover the NBT-PABA test remains a test of protein malabsorption of end-stage chronic pancreatitis. Fast MRCP Faecal chymotrypsin assay is a cheap test of pancreatic exocrine dysfunction with a sensitivity of49% in early and 80 - 90% in advanced chronic pancreatitis. * individual image pixels assigned a The cholesteryl-CG"-octanoate breath test is a recent innovative addition to high signal to represent ducts the category of highly sensitive and specific noninvasive tests of pancreatic * signal intensities adjusted to give a exocrine function.'5"16 volumetric appearance Most recently, the potential and precision of faecal elastase test in * post acquisition data processing using a maximum intensity comparison with the secretin-pancreozymin test in the diagnosis of chronic projection algorithm pancreatitis was evaluated.'7 There was good correlation between the output of * a three-dimensional work station faecal elastase and that of amylase, lipase and trypsin. Patients with chronic allows the image to be rotated and pancreatitis had significantly lower concentrations of enzyme than normal pruned of peripheral branches so controls. No significant decrease of immunoreactivity was found when stool that strictures and stones can be samples were stored at room temperature for over a week. In contrast to faecal clearly delineated in both common bile duct and main pancreatic duct chymotrypsin, the test results are unaffected by pancreatic enzyme replacement therapy. Box 2 Palliation of pain in chronic pancreatitis A better understanding of the pathophysiology and pathogenesis of chronic pancreatitis has revitalised therapeutic plans to palliate pain. Hence it is necessary to recapitulate the currently understood pathogenic mechanisms of pain before discussing its management. http://pmj.bmj.com/ MECHANISMS OF PAIN (BOX 4) Pancreatic tubeless tests: refinements & innovations Ductal hypertension NBT-PABA test In the normal human pancreas, unstimulated main duct pressure is about * administration of 30 mg/kg rather 7 mmHg. Bradley found that the mean ductal pressure was 25 mmHg in 19 than 15 mg/kg improves its patients with painful chronic pancreatitis and a dilated pancreatic duct.'8 Ductal discriminant power strictures and/or calculi cause obstruction and ductal hypertension. However, on September 27, 2021 by guest. Protected copyright. * spectrofluorometric estimation of ductal hypertension can occur in structurally normal pancreatic ducts and para-aminosalycilic acid & PABA in painful chronic pancreatitis. The restrictive effect of the parenchymal fibrosis in plasma
Recommended publications
  • Laparoscopic Longitudinal Pancreaticojejunostomy for Chronic Pancreatitis

    Laparoscopic Longitudinal Pancreaticojejunostomy for Chronic Pancreatitis

    JOP. J Pancreas (Online) 2015 Sep 08; 16(5):438-443. REVIEW ARTICLE Laparoscopic Longitudinal Pancreaticojejunostomy for Chronic Pancreatitis Tamotsu Kuroki, Susumu Eguchi Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan ABSTRACT function. Pancreatic ductal drainage is one of the most important factors for the management of chronic pancreatitis. A longitudinal pancreaticojejunostomyChronic pancreatitis is ischaracterized a simple and byradical severe surgical abdominal treatment pain for and pancreatic progressive ductal insufficiency drainage. However, of pancreatic in recent endocrine/exocrine years laparoscopic pancreatic procedures have developed rapidly, and reports concerning laparoscopic pancreatic resection including laparoscopic longitudinal for chronic pancreatitis compared with conventional open surgery are unclear. In this review, we note that laparoscopic longitudinal pancreaticojejunostomy ishave a technically increased feasible, in number. safe and Nevertheless, effective surgical the benefits procedure of inlaparoscopic selected patients longitudinal with chronic pancreaticojejunostomy pancreatitis. INTRODUCTION Laramée et al. [22] found that surgical drainage treatment was highly cost-effective compared to endoscopic In patients with chronic pancreatitis, severe recurrent drainage treatment for patients with obstructive chronic pancreatitis. debilitatingabdominal [1–7].pain Theand elevated functional pressure endocrine/exocrine in the pancreatic Laparoscopic surgery was
  • Total Pancreatectomy-Autologous Islet Cell Transplantation (TP-AIT) for Chronic Pancreatitis – What Defines Success?

    Total Pancreatectomy-Autologous Islet Cell Transplantation (TP-AIT) for Chronic Pancreatitis – What Defines Success?

    CellR4 2015; 3 (2): e1536 Total Pancreatectomy-Autologous Islet Cell Transplantation (TP-AIT) For Chronic Pancreatitis – What Defines Success? C. S. Desai, K. M. Khan, W. X. Cui Medstar Georgetown Transplant Institute, Washington, DC, USA Corresponding Author : Wanxing Cui, MD, Ph.D; e-mail: [email protected] ABSTRACT 30 per 100,000 in United States according to the Na - Chronic pancreatitis is an inflammatory disease tional Institutes of Diabetes, Digestive and Kidney which is characterized by irreversible morpho - diseases (http://www.niddk.nih.gov). Patients with logic changes that typically causes pain and per - chronic pancreatitis suffer from debilitating pain, manent loss of the functions. The lack of good which progresses to significant narcotic medication treatment options for patients with chronic pan - requirement and deterioration in quality of life. Pa - creatitis is in part is related to any therapy need - tients can undergo multiple endoscopic and surgical ing to address the “3Ps” that are necessary for intervention procedures without significant success. this disorder.1) Pain relief, 2) Prevention of brit - In one report, pain recurs in over 50 percent of pa - tle diabetes mellitus and 3) Prevention of pan - tients after having endoscopic surgical procedures 1. creatic cancer. Total pancreatectomy and Total pancreatectomy may ameliorate the pain of autologous islet cell transplant (TP-AIT) does chronic pancreatitis however the resultant severe offer a definitive therapy while addressing these brittle diabetes makes this a less than desirable op - three; however there has not been a universal tion. Autologous islet cell transplant after total pan - uptake of this treatment to consider it the stan - createctomy (TP-AIT) gives patients with chronic dard of care due to it being considered highly in - pancreatitis the hope of pain relief and reduces the vasive and success being measured mainly by the potential for brittle diabetes.
  • Puestow Modified Procedure in the Era of Advanced

    Puestow Modified Procedure in the Era of Advanced

    CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 15 (2015) 85–88 Contents lists available at ScienceDirect International Journal of Surgery Case Reports journa l homepage: www.casereports.com “Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report” a,∗,1 a,1 a,1 a,1 Georgios P. Fragulidis , Antonios Vezakis , Dionissios Dellaportas , Ira Sotirova , b,2 a,1 a,1 Vassilis Koutoulidis , Elliseos Kontis , Andreas Polydorou a 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece b 1st Department of Radiology, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece a r t i c l e i n f o a b s t r a c t Article history: INTRODUCTION: Pancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of Received 23 May 2015 intractable pain which is their main symptom. Decompression options of for the main pancreatic duct Received in revised form 14 August 2015 are both surgical and advanced endoscopic procedures. Accepted 14 August 2015 PRESENTATION OF CASES: A 64-year-old male with known CP due to alcohol consumption and a 36-year- Available online 20 August 2015 old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal Keywords: pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent Modified Puestow procedure results. Partington-Rochelle procedure DISCUSSION: Over the last 30 years, endoscopic procedures are developed to manage pancreatic duct Chronic lithiasic pancreatitis Surgical treatment strictures and calculi of the main pancreatic duct in CP patients.
  • Robotic Surgery for the Treatment of Chronic Pancreatitis. Pain Control, Narcotic Use Reduction and Re-Intervention Rate. Ten Years Follow-Up Retrospective Study

    Robotic Surgery for the Treatment of Chronic Pancreatitis. Pain Control, Narcotic Use Reduction and Re-Intervention Rate. Ten Years Follow-Up Retrospective Study

    isorders c D & ti a T e h r e c r a n p a y P ISSN: 2165-7092 Pancreatic Disorders & Therapy Research Article Robotic Surgery for the Treatment of Chronic Pancreatitis. Pain Control, Narcotic Use Reduction and Re-Intervention Rate. Ten Years Follow-Up Retrospective Study Eduardo Fernandes*, Valentina Valle, Gabriela Aguiluz Cornejo, Roberto Bustos, Roberto Mangano, Pier Cristoforo Giulianotti University of Illinois at Chicago College of Medicine Chicago, IL United States ABSTRACT Introduction: Surgical treatment of chronic pancreatitis is reserved to patients with intractable pain, pancreatic duct obstruction or suspicion of malignancy. Robotic surgery in this context has proven to be a safe and feasible. The aim of this study was to evaluate the effect of robotic assisted surgery in the context of chronic pancreatitis with regards to pain control, narcotic usage and need for re-intervention. Methods: A retrospective analysis of a prospectively collected divisional database at the University of Illinois Hospital & Health Sciences System was carried out. The primary endpoint was: 1) Evaluation of pre and post-operative pain and narcotic usage. The secondary endpoints were: 1) 10-year overall survival; and 2) ‘Event Free Survival’ (EFS). Results: 37 patients entered the study. The procedures performed were: pancreatic head resection (7), total pancreatectomy (1), hepatico-jejunostomy (6), longitudinal Roux-en-Y pancreato-jejunostomy (4), pancreato- gastrostomy (14) and thoracoscopic splanchnicectomy (7). The mean pre and post-operative pain scores were 6.5 and 4.5 respectively (p<0.05, paired Student t-test). Rates of narcotics use pre and post-surgery were 74% and 50% of patients respectively.
  • 2Nd Quarter 2001 Medicare Part a Bulletin

    2Nd Quarter 2001 Medicare Part a Bulletin

    In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care
  • Pancreas Transplantation: Review Transplante De Pâncreas: Revisão

    Pancreas Transplantation: Review Transplante De Pâncreas: Revisão

    REVIEW THEMATIC REVIEW: TRANSPLANTATION Pancreas transplantation: review Transplante de pâncreas: revisão Roberto Ferreira Meirelles Júnior1, Paolo Salvalaggio1, Alvaro Pacheco-Silva1,2 ABSTRACT Europa. A introdução dos imunossupressores tacrolimo e micofenolato Vascularized pancreas transplantation is the only treatment that mofetila, a partir de 1994, propiciou a melhora significativa dos resultados establishes normal glucose levels and normalizes glycosylated e a consequente realização de transplantes em escala crescente em hemoglobin levels in type 1 diabetic patients. The first vascularized vários países. Segundo o Registro Internacional de Transplante de pancreas transplant was performed by William Kelly and Richard Lillehei, Pâncreas, foram realizados, até 31 de dezembro de 2010, mais de 35 to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison mil transplantes de pâncreas. Sobrevida no primeiro ano dos pacientes e dos enxertos pancreáticos excede, respectivamente, 95 e 83%. A Teixeira performed the first isolated segmental pancreas transplant in melhor sobrevida dos enxertos pancreático (86%) e renal (93%), 1968. Until the 1980s, pancreas transplants were restricted to a few no primeiro ano pós-transplante, está na categoria de transplante centers of the United States and Europe. The introduction of tacrolimus simultâneo de pâncreas e rim. As perdas imunológicas no primeiro and mycophenolate mofetil in 1994, led to a significant outcome ano pós-transplante para transplante simultâneo de pâncreas e rim, improvement and consequently, an increase in pancreas transplants transplante de pâncreas após rim e transplante de pâncreas isolado in several countries. According to the International Pancreas Transplant foram, respectivamente, 1,8, 3,7, e 6%. O transplante de pâncreas Registry, until December 31st, 2010, more than 35 thousand pancreas apresenta de 10 a 20% de complicações cirúrgicas, necessitando transplants had been performed.
  • Open Modified Puestow Procedure in an Advanced Endoscopic Era For

    Open Modified Puestow Procedure in an Advanced Endoscopic Era For

    International Journal of Surgery Science 2020; 4(3): 71-76 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science Open modified puestow procedure in an advanced www.surgeryscience.com 2020; 4(3): 71-76 endoscopic era for chronic pancreatitis with dilated Received: 06-05-2020 Accepted: 08-06-2020 pancreatic duct and stones Dr. Ajay A Gujar Department of General Surgery, Dr. Ajay A Gujar, Dr. Amrita A Gujar and Dr. Aashay Dharia Amruta Surgical and Maternity Hospital, Mumbai, Maharashtra, DOI: https://doi.org/ 10.33545/surgery.2020.v4.i3b.471 India Dr. Amrita A Gujar Abstract K J Somaiya Hospital and Background: Chronic pancreatitis has been defined as a continuing inflammatory disease of the pancreas Research centre, Sion, Mumbai, characterized by irreversible morphological changes. These changes typically cause pain and loss of Maharashtra, India exocrine and endocrine pancreatic function. The most common symptom of chronic pancreatitis is pain, which can be severe and intractable in some Dr. Aashay Dharia patients. Although it is itself benign, chronic pancreatitis can significantly affect quality of life and can Dharia K J Somaiya Hospital and cause significant distress with its complications [1]. Research centre, Sion, Mumbai, The initial treatment for pain in most cases is to start of enzyme replacement, control of diabetes with Maharashtra, India insulin, and administration of oral analgesics. Surgical intervention is required in patients with intractable pain that is resistant to conventional nonsurgical therapy, in patients with associated or suspected malignancy, and in patients who have developed complications such as biliary or duodenal obstruction, pancreatic fistulae, pancreatic [2] ascites/pleural effusion, pseudocyst, or rare hemosuccus pancreaticus .
  • Review Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future

    Review Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future

    Hindawi Gastroenterology Research and Practice Volume 2017, Article ID 8418372, 6 pages https://doi.org/10.1155/2017/8418372 Review Article Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future Stephanie Plagemann, Maria Welte, Jakob R. Izbicki, and Kai Bachmann Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany Correspondence should be addressed to Stephanie Plagemann; [email protected] Received 14 March 2017; Revised 2 July 2017; Accepted 5 July 2017; Published 27 July 2017 Academic Editor: Riccardo Casadei Copyright © 2017 Stephanie Plagemann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The pancreas was one of the last explored organs in the human body. The first surgical experiences were made before fully understanding the function of the gland. Surgical procedures remained less successful until the discovery of insulin, blood groups, and finally the possibility of blood donation. Throughout the centuries, the surgical approach went from radical resections to minimal resections or only drainage of the gland in comparison to an adequate resection combined with drainage procedures. Today, the well-known and standardized procedures are considered as safe due to the high experience of operating surgeons, the centering of pancreatic surgery in specialized centers, and optimized perioperative treatment. Although surgical procedures have become safer and more efficient than ever, the overall perioperative morbidity after pancreatic surgery remains high and management of postoperative complications stagnates. Current research focuses on the prevention of complications, optimizing the patient’s general condition preoperatively and finding the appropriate timing for surgical treatment.
  • Laparoscopic Lateral Pancreaticojejunostomy for Chronic Pancreatitis; a Single Operator Tertiary Center Experience from Western India

    Laparoscopic Lateral Pancreaticojejunostomy for Chronic Pancreatitis; a Single Operator Tertiary Center Experience from Western India

    Research Article Clinics in Surgery Published: 28 Jan, 2019 Laparoscopic Lateral Pancreaticojejunostomy for Chronic Pancreatitis; a Single Operator Tertiary Center Experience from Western India Rege SA*, Kulkarni GV, Surpam Shrinivas, Amiteshwar Singh and Chiranjeev R Department of General Surgery, King Edward Memorial Hospital, India Abstract Introduction: Lateral Pancreaticojejunostomy (LPJ), has its recognized applications in the decompressive management of Chronic Pancreatitis (CP), and is recommended in patients with concomitant pain, obstructed, dilated pancreatic duct. Performing this procedure laparoscopically is technically challenging. We describe our technique and report our series of 33 patients who underwent this procedure. Methods: Between March 2013 and June 2018, 33 patients (19 males, 14 females) hailing from 5 different states in India, with an established diagnosis of CP underwent laparoscopic LPJ by a single surgeon in a tertiary care center in Western India. The median age and pancreatic duct diameter on CT were 41.8 (22 to 54) years and 8.73 (7 to 10) mm, respectively. Results: Thirty two patients were included in the final analysis in which the procedure was completed laparoscopically while one surgery necessitated conversion to open, owing to hemorrhage from the gastroduodenal artery. Median operating time was 131.2 (104 to 163) minutes and intraoperative blood loss of approximately 100 mL. There were no peri-operative deaths and no mortality at the six month follow up. No peri-operative blood transfusion was required, and the median postoperative hospital stay was 5.25 (5 to 8) days. Two patients required readmission at 8 months for pain. Twenty four patients reported to be nearly pain free on follow up while remaining 8 patients were managed OPEN ACCESS with appropriate analgesia without further procedures.
  • SOMC Surgical Lecture Series 1St Edition

    SOMC Surgical Lecture Series 1St Edition

    SOMC Surgical Lecture Series 1st Edition Thomas L. Khoury, MD FACS, RPVI, RVT, Professor of Surgery and Master Faculty OUHCOM Lecture Chapters Chapter 1: Care of the Surgical Patient Chapter 2: Care of the Angiography Patient Chapter 2: Nursing Symposium Care of the Surgical Patient Chapter 3: Fluids and Electrolytes Chapter 5: Surgical Critical Care Chapter 6: Wound Care Center Chapter 7: Cancer Screening Symposium Chapter 7: Cutaneous Neoplasms Chapter 8: Breast Diseases Chapter 9: Endocrine Surgery Chapter 9: The Pancreas Chapter 10: The Esophagus Chapter 11: The Stomach Chapter 12: Small Bowel Chapter 13: Liver and Biliary Tree Chapter 14: The Colon Chapter 15: Lung Cancer Surgery Chapter 16: Abdominal Compartment Syndrome Chapter 16: Carotid Stenting Chapter 16: Dialysis Access Evaluation Chapter 16: Minimally Invasive Vascular Interventions Chapter 16: Vascular Surgery Chapter 18: Arterial Aneurysm Disease: Natural History, Chapter 18: Critical Limb Ischemia Chapter 20: DVT Treatment Chapter 20: Heparin Induced Thrombocytopenia Chapter 20: Iliofemoral DVT Chapter 20: Thrombolytic Therapy in the Management of Deep Venous Thrombosis Chapter 20: Venous Disease Grand Rounds Chapter 20: Venous Disease Ground Rounds Chapter 21: Thrombolytic Therapy for Significant Pulmonary Embolic Chapter 1: Care of the Surgical Patient > Over 70 > Overall Physical status Assessment of Operative Risk > Elective v/s Emergency > Physiologic Extent of Age Procedure > Number of Associated Illnesses > Psychological frank but optimistic Preparation of Patient
  • Laparoscopic Donor Distal Pancreatectomy for Living Donor Pancreas and Pancreas–Kidney Transplantation

    Laparoscopic Donor Distal Pancreatectomy for Living Donor Pancreas and Pancreas–Kidney Transplantation

    American Journal of Transplantation 2005; 5: 1966–1970 Copyright C Blackwell Munksgaard 2005 Blackwell Munksgaard doi: 10.1111/j.1600-6143.2005.00950.x Laparoscopic Donor Distal Pancreatectomy for Living Donor Pancreas and Pancreas–Kidney Transplantation Miguel Tan, Raja Kandaswamy, David ER high panel-reactive antibody (PRA) who is unlikely to re- ∗ Sutherland and Rainer WG Gruessner ceive a cadaver organ. Before 1994, our institution only of- fered an LD pancreas transplant as a pancreas transplant Department of Surgery, Division of Transplantation, alone (PTA) or as a pancreas after kidney (PAK) transplant, University of Minnesota, MN because of the fear that multiorgan retrieval from an LD ∗ Corresponding author: Rainer WG Gruessner, entailed too much morbidity (4). With that approach, how- [email protected] ever, diabetic uremic patients had to endure two separate procedures, which many patients were loath to undergo. With the proliferation and expanding applications of Even today, patients will sometimes pass up a single organ laparoscopic techniques, we determined the applica- in order to undergo a simultaneous pancreas–kidney (SPK) bility of the laparoscopic approach to living pancreas transplant despite its prolonged waiting time. donation. We performed the first laparoscopic donor distal pancreatectomy in 1999. We herein present our It has also been demonstrated that diabetic patients on initial experience with five hand-assisted laparoscopic dialysis have increased morbidity and mortality, as com- donor pancreatectomies. Three donors underwent dis- pared with nondiabetic patients on dialysis. Diabetic pa- tal pancreatectomy alone; two underwent a simultane- tients undergoing a kidney transplant alone (KTA) have a ± ous left nephrectomy. The mean donor age was 48.4 higher mortality rate as compared with those undergoing 8.7 years with a body mass index of 23.7 kg/m2.
  • Chronic Pancreatitis: Introduction

    Chronic Pancreatitis: Introduction

    Chronic Pancreatitis: Introduction Authors: Anthony N. Kalloo, MD; Lynn Norwitz, BS; Charles J. Yeo, MD Chronic pancreatitis is a relatively rare disorder occurring in about 20 per 100,000 population. The disease is progressive with persistent inflammation leading to damage and/or destruction of the pancreas . Endocrine and exocrine functional impairment results from the irreversible pancreatic injury. The pancreas is located deep in the retroperitoneal space of the upper part of the abdomen (Figure 1). It is almost completely covered by the stomach and duodenum . This elongated gland (12–20 cm in the adult) has a lobe-like structure. Variation in shape and exact body location is common. In most people, the larger part of the gland's head is located to the right of the spine or directly over the spinal column and extends to the spleen . The pancreas has both exocrine and endocrine functions. In its exocrine capacity, the acinar cells produce digestive juices, which are secreted into the intestine and are essential in the breakdown and metabolism of proteins, fats and carbohydrates. In its endocrine function capacity, the pancreas also produces insulin and glucagon , which are secreted into the blood to regulate glucose levels. Figure 1. Location of the pancreas in the body. What is Chronic Pancreatitis? Chronic pancreatitis is characterized by inflammatory changes of the pancreas involving some or all of the following: fibrosis, calcification, pancreatic ductal inflammation, and pancreatic stone formation (Figure 2). Although autopsies indicate that there is a 0.5–5% incidence of pancreatitis, the true prevalence is unknown. In recent years, there have been several attempts to classify chronic pancreatitis, but these have met with difficulty for several reasons.