Geographical variance in reporting of elective surgery for chronic pancreatitis.

The selection of optimum surgical procedure from the range of reported operations for chronic pancreatitis (CP) can be difficult. The aim of this study is to explore geographical variation in reporting of elective surgery for CP. A systematic search of the literature was performed using the Scopus database for reports of five selected procedures for CP: duodenum-preserving pancreatic head resection, total pancreatectomy with islet autotransplantation (TPIAT), Frey pancreaticojejunostomy, thoracoscopic splanchnotomy and the Izbicki V-shaped resection. The keyword and MESH heading 'chronic pancreatitis' was used. Overall, 144 papers met inclusion criteria and were utilized for data extraction. There were 33 reports of duodenum-preserving pancreatic head resection. Twenty-one (64%) were from Germany. There were 60 reports of TPIAT, 53 (88%) from the USA. There are only two reports of TPIAT from outwith the USA and UK. The 34 reports of the Frey pancreaticojejunostomy originate from 12 countries. There were 20 reports of thoracoscopic splanchnotomy originating from nine countries. All three reports of the Izbicki 'V' procedure are from Germany. There is geographical variation in reporting of surgery for CP. There is a need for greater standardization in the selection and reporting of surgery for patients with painful CP.

Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence.

INTRODUCTION: For the surgical management of chronic pancreatitis with an inflammatory pancreatic head mass, extended drainage operations such as Beger and Frey procedures were established in the 1980s as an alternative to resectional procedures like pancreaticoduodenectomy and as opposed to simple drainage operations such as lateral pancreaticojejunostomy, that is, the Partington procedure. With the relatively rapid adoption of the two procedures, it seems that the Partington procedure has become a thing of the past. MATERIALS AND METHODS: The Partington procedure was re-evaluated with regard to the historical aspects and its present status by a literature review. RESULTS: The results show that this procedure relieves chronic abdominal pain in 66-91% of patients with a mean follow-up of 3.5-9.1 years. It is important to note that this procedure is generally used for inflammatory disease left of the gastroduodenal artery and is specifically not used as the procedure of choice for inflammatory disease of the pancreatic head. CONCLUSION: For patients with a dilated main pancreatic duct but without an inflammatory pancreatic head mass, the Partington procedure is still the procedure of choice, since it is technically simple to perform with a minimum of morbidity and mortality, preserving pancreatic endocrine and exocrine function. Because it is a relatively simple technique, the laparoscopic approach will be justified as a treatment of appropriate patients in the near future.

Changing trends in operations for chronic pancreatitis: a 22-year experience.

OBJECTIVE: To report the evolution of methods of surgical treatment of chronic pancreatitis. DESIGN: Retrospective analysis. SETTING: Private clinic, USA. SUBJECTS: 448 consecutive patients who were operated on for chronic pancreatitis. INTERVENTIONS: Resection (n = 286) or drainage of the duct (n = 162). MAIN OUTCOME MEASURE: Changes over the 22-year period. RESULTS: There was a change towards resection after 1985 (195/238, 59%, from 1976-90 compared with 91/120, 76%, from 1991-97), partly because of suspicions of malignancy. In recent years (1991-97) pylorus-preserving pancreaticoduodenectomy has come to be preferred over classic resection including antrectomy (22/36, 61%, compared with 11/69, 16%). Eight duodenum-preserving resections have been done since 1994. CONCLUSIONS: More resections, particularly proximal pancreatectomies, are done nowadays. Lateral pancreaticojejunostomy has become the preferred drainage procedure, and pylorus-preserving pancreaticoduodenectomy is favoured over classic pancreaticoduodenectomy.

Pancreatogastroanastomosis luego de la operación de Whipple / Pancreatogastroanastomoses after Whipple technique

Antecedentes: Después de la resección pancreaticoduodenal la fístula pancreática es una temida complicación, con una mortalidad estimada del 10 al 20 por ciento de los casos. Objetivo: Intentar reducir la frecuencia y la severidad de la fístula anastomótica postoperatoria luego de la pancreatoyeyunoanastomosis (PYA) en pacientes con dduodenopancreatectomía cefálica (DPC). Resumen: La pancreatogastroanastomosis (PGA) se realizó como una reconstrucción alternativa luego de DPC. Desde 1991 a 1997 hemos realizado 15 DPC. En 9 pacientes empleamos la PGA y en 6 la PYA. La mortalidad fue del 0 por ciento. Pero la morbilidad alcanzó el 56 por ciento. La fístula pancreática estuvo presente en el 13 por ciento del grupo de PYA y 0 por ciento en PGA. Conclusión: Estos resultados confirman que la PGA es un seguro método de reconstrucción luego de la DPC

Pancreatogastroanastomosis luego de la operación de Whipple / Pancreatogastroanastomoses after Whipple technique

Antecedentes: Después de la resección pancreaticoduodenal la fístula pancreática es una temida complicación, con una mortalidad estimada del 10 al 20 por ciento de los casos. Objetivo: Intentar reducir la frecuencia y la severidad de la fístula anastomótica postoperatoria luego de la pancreatoyeyunoanastomosis (PYA) en pacientes con dduodenopancreatectomía cefálica (DPC). Resumen: La pancreatogastroanastomosis (PGA) se realizó como una reconstrucción alternativa luego de DPC. Desde 1991 a 1997 hemos realizado 15 DPC. En 9 pacientes empleamos la PGA y en 6 la PYA. La mortalidad fue del 0 por ciento. Pero la morbilidad alcanzó el 56 por ciento. La fístula pancreática estuvo presente en el 13 por ciento del grupo de PYA y 0 por ciento en PGA. Conclusión: Estos resultados confirman que la PGA es un seguro método de reconstrucción luego de la DPC (AU)