The impact of surgical strategies on outcomes for pediatric chronic pancreatitis.
Pediatr Surg Int
; 33(1): 75-83, 2017 Jan.
Article
em En
| MEDLINE
| ID: mdl-27815641
ABSTRACT
PURPOSE:
To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief.METHODS:
Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated.RESULTS:
Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7-20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2-5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006-0.57; OR 0.07; 95%, CI 0.01-0.89). However, these associations were not present in multivariate analysis.CONCLUSION:
In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pâncreas
/
Pancreatectomia
/
Pancreaticojejunostomia
/
Transplante de Pâncreas
/
Guias de Prática Clínica como Assunto
/
Pancreatite Crônica
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Adolescent
/
Adult
/
Child
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Pediatr Surg Int
Assunto da revista:
PEDIATRIA
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Estados Unidos