Pancreatectomía central: relato de casos y descripción de la técnica / Central pancreatectomy: cases report and technique description

The conventional techniques of pancreatic resections, most of the time imply in the withdrawal of ex-tensive segments of pancreatic parenchyma, having as possible complications at the long time, the appearance of endocrine or exocrine insufficience. The central pancreatectomy consists in an alternative of pancreatic resection to resect benign or low grade malignant tumours located in the pancreatic isthmus. We present the clinical characteristics, image, and the surgical technique used, for withdraw of pancreatic isthmus nonfunctioning pancreatic neuroendocrine neoplasm and pancreatic serous cystic adenoma.

Las técnicas convencionales de resección pancreática para el tratamiento de enfermedades neoplásicas, en la mayoría de las veces implican la extirpación de segmentos extensos del parénquima pancreático, existiendo como eventuales complicaciones a largo plazo, el surgimiento de insuficiencia pancreática endocrina o exocrina. La pancreatectomía central se constituye en una alternativa de resección pancreática, que limita esta resección solamente al sector comprometido, especialmente en las neoplasias benignas o de bajo grado de malignidad. Presentamos las características clínicas, de imagen y la técnica empleada en dos pacientes, para el tratamiento quirúrgico de un tumor endocrino no funcionante y de un cistoadenoma seroso, localizados en el cuello del páncreas, mediante la pancreatectomía central.

Evaluation of the effects of noniodinized and iodinized ionic contrast media and gadoteric acid in acute necrotizing pancreatitis: experimental study in rabbits.

OBJECTIVE: To evaluate the effects of iodine contrast media and gadoteric acid in acute necrotizing pancreatitis. METHODS: Fifty rabbits were distributed in 5 groups: 10 rabbits were assigned in the control group (group 5) and 40 rabbits were assigned in the pancreatitis group, wherein acute necrotizing pancreatitis was induced through retrograde injection of 5% sodium taurocholate (1 mL/kg weight) in the main pancreatic duct. After 3 hours, they were randomized to receive endovenous iodinized nonionic contrast medium (group 1), iodinized ionic contrast medium (group 2), gadoteric acid (group 3), and physiological serum at 0.9% (group 4). Six hours after induction of pancreatitis, these animals were reoperated. During surgery, pancreatic tissue flow through laser Doppler, hematometric values, biochemistry, and histopathology analysis by hematoxylin and eosin were done. Statistical analysis using Kruskal-Wallis, Fisher-Freeman-Halton, and parametric t tests was performed. RESULTS: There was statistical significance when comparing tissue flow before and after induction of pancreatitis (P < 0.0001). Ionic and nonionic contrast media and gadoteric acid did not increase the grade of pancreatic necrosis (P > 0.05). CONCLUSIONS: Ionic and nonionic contrast media and gadoteric acid did not produce adverse effects in the present model of acute necrotizing pancreatitis.

Insulinoma de páncreas / Pancreatic insulinomas

El insulinoma es la neoplasia más frecuente del grupo de tumores neuroendocrinos de páncreas. En el presente estudio se evaluaron los resultados clínicos e inmunohistoquímicos de 20 casos de pacientes tratados quirúrgicamente desde enero de 1986 hasta diciembre de 2004. Se describió el cuadro clínico, los exámenes de laboratorio e imageneológicos, y se hizo énfasis en los aspectos quirúrgicos, las complicaciones y el seguimiento a medio y largo plazo. La cirugía se indicó sobre la base de las evidencias clínicas y analíticas de hipoglucemia e hiperinsulinemia. En 15 pacientes se logró la localización previa de la lesión, en 5, su localización fue identificada durante la cirugía mediante la palpación y a través del ultrasonido intraoperatorio. Los procedimientos quirúrgicos realizados con más frecuencia fueron la resección pancreática en la mitad de los pacientes y la enucleación por laparotomía en la otra mitad. En 2 pacientes se utilizó la vía laparoscópica. Dos presentaron tardíamente diabetes mellitus. La complicación quirúrgica más frecuente fue la fístula pancreática en 13 de los casos. No hubo mortalidad en la presente serie. En la totalidad de los pacientes se obtuvo la reversión clínica de los síntomas, caracterizada por la desaparición de la tríada de Whipple, además de la normalización o el aumento de los valores de glucemia, comparados con los valores del preoperatorio (AU)

Insulinoma is the most frequent neuroendocrine pancreatic tumor. In the present study, the clinical and immunohistochemical results of 20 patients who underwent surgery between January 1986 and December 2004 were evaluated. Clinical presentation, laboratory data, imaging studies, aspects of the surgical technique, complication rates and medium- and long-term follow-up were analyzed. Surgical treatment was recommended in all patients based on presenting symptoms and laboratory signs of hypoglycemia and hyperinsulinemia. In 15 patients, the lesion was identified preoperatively. In the 5 remaining patients, intraoperative palpation and ultrasonography were used to locate the lesion. The most frequently performed surgical procedures were pancreatic resection in 10 patients and laparotomic enucleation in the remaining 10. Laparoscopy was used in two patients. Two patients developed diabetes mellitus. The most frequent surgical complication was pancreatic fistula. No mortality was observed in the present series. Symptom reversion, characterized by disappearance of Whipple's triad and normal or increased glycemia values compared with preoperative values, was observed in all patients (AU)

[Pancreatic insulinomas]. / Insulinoma de páncreas.

Insulinoma is the most frequent neuroendocrine pancreatic tumor. In the present study, the clinical and immunohistochemical results of 20 patients who underwent surgery between January 1986 and December 2004 were evaluated. Clinical presentation, laboratory data, imaging studies, aspects of the surgical technique, complication rates and medium- and long-term follow-up were analyzed. Surgical treatment was recommended in all patients based on presenting symptoms and laboratory signs of hypoglycemia and hyperinsulinemia. In 15 patients, the lesion was identified preoperatively. In the 5 remaining patients, intraoperative palpation and ultrasonography were used to locate the lesion. The most frequently performed surgical procedures were pancreatic resection in 10 patients and laparotomic enucleation in the remaining 10. Laparoscopy was used in two patients. Two patients developed diabetes mellitus. The most frequent surgical complication was pancreatic fistula. No mortality was observed in the present series. Symptom reversion, characterized by disappearance of Whipple's triad and normal or increased glycemia values compared with preoperative values, was observed in all patients.