Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial.
J. R. Izbicki,Christian Bloechle,Wolfram T. Knoefel,T Kuechler,K. F. Binmoeller,Christoph E. Broelsch +5 more
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TLDR
Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and definitive control of complications affecting adjacent organs.Abstract:
OBJECTIVE: Two techniques of duodenum-preserving resection of the head of the pancreas were compared in a prospective, randomized trial. The technical feasibility and effects on quality of life were assessed. SUMMARY BACKGROUND DATA: Drainage and resection are the principles of surgery in chronic pancreatitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Berger and Frey combine both to different degrees. The efficacy of both procedures has not been compared thus far. METHODS: Forty-two patients were allocated randomly to either Beger's (n = 20) or Frey's (n = 22) group. In addition to routine pancreatic diagnostic work-up, a multidimensional psychometric quality-of-life questionnaire and and a pain score were used. Assessment of endocrine and exocrine function included oral glucose tolerance test, serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl test. The interval between symptoms and surgery ranged from 12 months to 12 years, with a mean of 5.7 years. The mean follow-up was 1.5 years. RESULTS: There was no mortality. Overall morbidity was 14% (20% Beger, 9% Frey). Complications from adjacent organs were resolved definitively in 94% (90% Beger, 100% Frey). A decrease of 95% and 94% of the pain score after Beger's and Frey's procedure, respectively, and an increase of 67% of the overall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between both groups. CONCLUSIONS: Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and definitive control of complications affecting adjacent organs. Neither procedure leads to further deterioration of endocrine and exocrine pancreatic function.read more
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Ten-Year Experience With 733 Pancreatic Resections: Changing Indications, Older Patients, and Decreasing Length of Hospitalization
James H. Balcom,David W. Rattner,Andrew L. Warshaw,Yuchiao Chang,Carlos Fernandez-del Castillo +4 more
TL;DR: There has been a significant decrease in LOS; this is the result of implementation of case management and clinical pathways, increasing case volume, decreasing incidence of delayed gastric emptying, and decreasing use of pylorus-preserving PD.
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Human pancreatic exocrine response to nutrients in health and disease.
TL;DR: A comprehensive knowledge about the physiological pancreatic exocrine response to normal diets and to individual food components is necessary to administer a pancreatic enzyme preparation which imitates physiological conditions closely.
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Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy.
J. R. Izbicki,Christian Bloechle,Dieter C. Broering,Wolfram T. Knoefel,T Kuechler,Christoph E. Broelsch +5 more
TL;DR: Both procedures are equally effective in terms of pain relief and definitive control of complications affecting adjacent organs, but extended drainage by LPJ-LPHE provides a better quality of life.
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AGA technical review: Treatment of pain in chronic pancreatitis
Andrew L. Warshaw,Andrew L. Warshaw,Peter A. Banks,Peter A. Banks,Carlos Fernandez-del Castillo,Carlos Fernandez-del Castillo +5 more
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Pancreatic resection: effects on glucose metabolism.
Lori A. Slezak,Dana K. Andersen +1 more
TL;DR: Operative considerations for the treatment of Pancreatic disease should include strategies to minimize the hormonal impairment of pancreatic resection, which is associated with a lower incidence of new or worsened diabetes.
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Journal Article
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TL;DR: In both groups lasting relief from pain was correlated with the duration of the disease and was associated with marked pancreatic dysfunction; the 50% survival time in alcoholic chronic pancreatitis was 20-24 yr (after onset), thus markedly shorter than in nonalcoholic pancreatitis.
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Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease.
TL;DR: The natural course of the classical symptoms of chronic pancreatitis, i.e., pain, exocrine and endocrine pancreatic insufficiency, was followed up in 335 patients over a median of 9.8 years as mentioned in this paper.
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