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Delayed necrosectomy in severe acute necrotizing pancreatitis: Experience from a tertiary care centre
Abstracts / Pancreatology 14 (2014) S1–S10
pancreatic duct (>5 mm) underwent lateral pancreatojejunostomy (40;33%), Frey procedure (19;16%), other resections [such as distal pancreatectomy (7;6%), pancreatoduodenectomy (10;8%)], pseudocyst drainage (25;20.5%), biliary enteric anastomosis (36;29.5%), gastrojejunostomy (15;12.2%) and aneurysmorrhaphy (13;11%). Three (2.5%) patients died in the postoperative period. Over a median follow up of 60 months (6–280 months) satisfactory pain relief was obtained in patients (81%). There were 6 late deaths on follow up (3 due to pancreatic cancer). Conclusions: About two-thirds of the patients with ACP were suitable for ductal drainage or resectional procedures and, in the remaining surgery was tailored to treat the complications of ACP. Lasting and satisfactory pain relief was achieved in 81% of the patients with an acceptable operative mortality.
S7
Results: Between January 1985 and December 2013, 188 patients underwent surgery for NACP [111 males and 77 females; median age: 27 (5-72) years]. Indications for surgery were pain (94%), biliary obstruction (21%), pseudocysts (17%), portal hypertension (12%), pancreatic head mass (10%), duodenal obstruction (7%), pseudoaneurysm (6%) and pancreatic ascites (3%). Drainage procedures (Latero-lateral pancreaticojejunostomy or Frey’s) were done for 119(63%) patients and 18(10%) patients underwent resectional procedures. In-hospital operative mortality was 2.1% (4/188). A total of 136 patients (74%) were followed up for a median duration of 60 months (6 – 300 months), satisfactory pain relief was obtained in 125(92%). Eleven patients expired in the follow up (6 due to disseminated pancreatic cancer). Conclusion: Surgery is safe and provides lasting pain relief in majority of patients with NACP. Occurrence of pancreatic cancer is responsible for majority of late deaths.
18. Acinar cell regeneration in chronic pancreatitis: preliminary studies
20.
Ramaiah Jangala 1, Aparna Jakkampudi 1, Meduri madhavi 1, Rupjyoti Talukdar 1,2, Sasikala Mitnala 1, P. Pavan kumar 1, D. Nageshwar Reddy 2
Delayed necrosectomy in severe acute necrotizing pancreatitis: Experience from a tertiary care centre V. Arun, P. Patnaik, S. Pal, N.R. Dash, P. Garg, K.S. Madhusudhan, P. Sahni
1
Asian Healthcare Foundation, Hyderabad, India 2 Asian Institute of Gastroenterology, India Introduction: Chronic pancreatitis (CP) is characterized by irreversible pancreatic damage resulting in exocrine/endocrine dysfunction. Currently no curative treatment exists for CP. It is not know if there is acinar regeneration in CP unlike in AP. Demonstration of acinar regeneration in CP could leads to development of curative treatment. We evaluated if there is acinar cell regeneration in CP in this preliminary study. Methods: Experiments was performed on pancreatic tissue obtained from specimens of CP patient undergoing pancreatic resection/drainage for pain. Normal pancreata collected from patient undergoing surgery for periampullary adenomas/pancreatic cystic lesions (nonmalignant) constituted controls. Immunofluorescence(IF) was performed to assess beta-catenin (a transcription factor required for maturation and maintenance of pancreatic acinar cells; and acinar regeneration after AP). Ki-67 (cell proliferation marker) was also evaluated. In order to localize the beta catenin positive cells, concomitant immunostaining for insulin was performed. Result: Study was conducted on 4 CP and 3 controls samples. Mean (þ/-SD) duration after diagnosis of CP was 18þ/-3.5 months. Patient mean (þ/-SD) age was 22.3(3.4)yrs. Compared to 2 (þ/-0.6) % in control tissue, CP tissue showed 17.8 (þ/- 4.9)% beta catenin positive cells. Beta catenin was observed in cells outside the islets (on merged images), implying them to be acinar cells. There was no difference in Ki-67 positive cell fraction (2.3% vs. 2.8%) between control and CP, implying absence of proliferation. Conclusion: our preliminary results suggest that there is acinar cell regeneration in CP, Which occur via non-proliferative mechanisms. Further studies are required to confirm the regenerative mechanisms.
19. Surgical management of non-alcoholic chronic pancreatitis (NACP) at a tertiary care centre in India Rajesh Panwar, Vishnu Prasad Ravella, Arif Ali Khan, Sujoy Pal, Nihar Ranjan Dash, Pramod Garg, Peush Sahni Department of Gastrointestinal Surgery and Liver transplantation, All India Institute of Medical Sciences, India Background: Unlike western countries, almost 60% of chronic pancreatitis cases in India are of non-alcoholic etiology. There is limited data on long term outcome of these patients following surgical treatment. Methods: The records of all patients who underwent surgery for nonalcoholic chronic pancreatitis (NACP) in the Department of Gastrointestinal Surgery and Liver transplantation, All India Institute of Medical Sciences since January 1985 were reviewed. The relevant preoperative, intraoperative, postoperative and follow up data were extracted from a prospectively maintained database.
Introduction: In severe acute necrotizing pancreatitis delaying surgery till at least 3 to 4 weeks leads to lower morbidity and mortality rates compared to early intervention. We aimed to determine the effect of timing of surgical intervention on mortality. Methods: Patients undergoing pancreatic necrosectomy over a 13-year period (2000-2013) were identified retrospectively from a prospectively maintained database. Data on hospital course and outcome were extracted from the database. The study population was divided into two groups: early intervention (<4 weeks) and delayed intervention (>4 weeks) groups. Results: One hundred patients underwent necrosectomy for infected pancreatic necrosis. Their mean age was 36.211.71 years with a male preponderance (3:1). The most common aetiology was gallstones followed by alcohol and idiopathic pancreatitis. Twenty-three patients had early intervention and seventy-seven had late intervention. The mean symptom onset to surgery interval between two groups was 16.87.2 vs 58.227.9 days (p<0.001). CT severity index score >8 (73% vs 75%), preoperative organ failure (52% vs 40%), retroperitoneal necrosis (14% vs 21%), frequency of intraoperative packing (33% vs 30%) and adjacent organ necrosis (12% vs 10%) were similar in the two groups. Preoperative percutaneous drainage was done more frequently in the delayed intervention group (41% vs 65%, p¼0.048). The overall mortality was 42%; 60% in the early and 36% in the delayed intervention group (p¼0.037). Conclusion: Pancreatic necrosectomy at >4 weeks after the onset of symptoms was associated with a significantly lower mortality.
21. Prediction of pancreatic fistula and fibrosis in patients undergoing pancreatic resections using differential pancreatic enhancement pattern on multi phasic computed tomography (MPCT) scan: A prospective study Arif Ali Khan 1, Sujoy Pal 1, Raju Sharma 2, Ajay K. Yadav 2, N.R. Dash 1, S. Datta Gupta 3, Sandeep Mathur 3, Peush Sahni 1 1 Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 2 Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 3 Department of Pathology, All India Institute of Medical Sciences, New Delhi
Introduction: Pancreatic resections are associated with postoperative pancreatic fistula (POPF). A firm pancreas, which is related to pancreatic fibrosis, is less likely to develop POPF. We used specialized MPCT to assess pancreatic enhancement at the resection margin and its relation to the degree of fibrosis and risk of POPF. Methods: Between June 2012 and December 2013 all patients undergoing Whipple (PD), or distal (DP)/central pancreatectomy (CP) underwent
pancreatic duct (>5 mm) underwent lateral pancreatojejunostomy (40;33%), Frey procedure (19;16%), other resections [such as distal pancreatectomy (7;6%), pancreatoduodenectomy (10;8%)], pseudocyst drainage (25;20.5%), biliary enteric anastomosis (36;29.5%), gastrojejunostomy (15;12.2%) and aneurysmorrhaphy (13;11%). Three (2.5%) patients died in the postoperative period. Over a median follow up of 60 months (6–280 months) satisfactory pain relief was obtained in patients (81%). There were 6 late deaths on follow up (3 due to pancreatic cancer). Conclusions: About two-thirds of the patients with ACP were suitable for ductal drainage or resectional procedures and, in the remaining surgery was tailored to treat the complications of ACP. Lasting and satisfactory pain relief was achieved in 81% of the patients with an acceptable operative mortality.
S7
Results: Between January 1985 and December 2013, 188 patients underwent surgery for NACP [111 males and 77 females; median age: 27 (5-72) years]. Indications for surgery were pain (94%), biliary obstruction (21%), pseudocysts (17%), portal hypertension (12%), pancreatic head mass (10%), duodenal obstruction (7%), pseudoaneurysm (6%) and pancreatic ascites (3%). Drainage procedures (Latero-lateral pancreaticojejunostomy or Frey’s) were done for 119(63%) patients and 18(10%) patients underwent resectional procedures. In-hospital operative mortality was 2.1% (4/188). A total of 136 patients (74%) were followed up for a median duration of 60 months (6 – 300 months), satisfactory pain relief was obtained in 125(92%). Eleven patients expired in the follow up (6 due to disseminated pancreatic cancer). Conclusion: Surgery is safe and provides lasting pain relief in majority of patients with NACP. Occurrence of pancreatic cancer is responsible for majority of late deaths.
18. Acinar cell regeneration in chronic pancreatitis: preliminary studies
20.
Ramaiah Jangala 1, Aparna Jakkampudi 1, Meduri madhavi 1, Rupjyoti Talukdar 1,2, Sasikala Mitnala 1, P. Pavan kumar 1, D. Nageshwar Reddy 2
Delayed necrosectomy in severe acute necrotizing pancreatitis: Experience from a tertiary care centre V. Arun, P. Patnaik, S. Pal, N.R. Dash, P. Garg, K.S. Madhusudhan, P. Sahni
1
Asian Healthcare Foundation, Hyderabad, India 2 Asian Institute of Gastroenterology, India Introduction: Chronic pancreatitis (CP) is characterized by irreversible pancreatic damage resulting in exocrine/endocrine dysfunction. Currently no curative treatment exists for CP. It is not know if there is acinar regeneration in CP unlike in AP. Demonstration of acinar regeneration in CP could leads to development of curative treatment. We evaluated if there is acinar cell regeneration in CP in this preliminary study. Methods: Experiments was performed on pancreatic tissue obtained from specimens of CP patient undergoing pancreatic resection/drainage for pain. Normal pancreata collected from patient undergoing surgery for periampullary adenomas/pancreatic cystic lesions (nonmalignant) constituted controls. Immunofluorescence(IF) was performed to assess beta-catenin (a transcription factor required for maturation and maintenance of pancreatic acinar cells; and acinar regeneration after AP). Ki-67 (cell proliferation marker) was also evaluated. In order to localize the beta catenin positive cells, concomitant immunostaining for insulin was performed. Result: Study was conducted on 4 CP and 3 controls samples. Mean (þ/-SD) duration after diagnosis of CP was 18þ/-3.5 months. Patient mean (þ/-SD) age was 22.3(3.4)yrs. Compared to 2 (þ/-0.6) % in control tissue, CP tissue showed 17.8 (þ/- 4.9)% beta catenin positive cells. Beta catenin was observed in cells outside the islets (on merged images), implying them to be acinar cells. There was no difference in Ki-67 positive cell fraction (2.3% vs. 2.8%) between control and CP, implying absence of proliferation. Conclusion: our preliminary results suggest that there is acinar cell regeneration in CP, Which occur via non-proliferative mechanisms. Further studies are required to confirm the regenerative mechanisms.
19. Surgical management of non-alcoholic chronic pancreatitis (NACP) at a tertiary care centre in India Rajesh Panwar, Vishnu Prasad Ravella, Arif Ali Khan, Sujoy Pal, Nihar Ranjan Dash, Pramod Garg, Peush Sahni Department of Gastrointestinal Surgery and Liver transplantation, All India Institute of Medical Sciences, India Background: Unlike western countries, almost 60% of chronic pancreatitis cases in India are of non-alcoholic etiology. There is limited data on long term outcome of these patients following surgical treatment. Methods: The records of all patients who underwent surgery for nonalcoholic chronic pancreatitis (NACP) in the Department of Gastrointestinal Surgery and Liver transplantation, All India Institute of Medical Sciences since January 1985 were reviewed. The relevant preoperative, intraoperative, postoperative and follow up data were extracted from a prospectively maintained database.
Introduction: In severe acute necrotizing pancreatitis delaying surgery till at least 3 to 4 weeks leads to lower morbidity and mortality rates compared to early intervention. We aimed to determine the effect of timing of surgical intervention on mortality. Methods: Patients undergoing pancreatic necrosectomy over a 13-year period (2000-2013) were identified retrospectively from a prospectively maintained database. Data on hospital course and outcome were extracted from the database. The study population was divided into two groups: early intervention (<4 weeks) and delayed intervention (>4 weeks) groups. Results: One hundred patients underwent necrosectomy for infected pancreatic necrosis. Their mean age was 36.211.71 years with a male preponderance (3:1). The most common aetiology was gallstones followed by alcohol and idiopathic pancreatitis. Twenty-three patients had early intervention and seventy-seven had late intervention. The mean symptom onset to surgery interval between two groups was 16.87.2 vs 58.227.9 days (p<0.001). CT severity index score >8 (73% vs 75%), preoperative organ failure (52% vs 40%), retroperitoneal necrosis (14% vs 21%), frequency of intraoperative packing (33% vs 30%) and adjacent organ necrosis (12% vs 10%) were similar in the two groups. Preoperative percutaneous drainage was done more frequently in the delayed intervention group (41% vs 65%, p¼0.048). The overall mortality was 42%; 60% in the early and 36% in the delayed intervention group (p¼0.037). Conclusion: Pancreatic necrosectomy at >4 weeks after the onset of symptoms was associated with a significantly lower mortality.
21. Prediction of pancreatic fistula and fibrosis in patients undergoing pancreatic resections using differential pancreatic enhancement pattern on multi phasic computed tomography (MPCT) scan: A prospective study Arif Ali Khan 1, Sujoy Pal 1, Raju Sharma 2, Ajay K. Yadav 2, N.R. Dash 1, S. Datta Gupta 3, Sandeep Mathur 3, Peush Sahni 1 1 Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 2 Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 3 Department of Pathology, All India Institute of Medical Sciences, New Delhi
Introduction: Pancreatic resections are associated with postoperative pancreatic fistula (POPF). A firm pancreas, which is related to pancreatic fibrosis, is less likely to develop POPF. We used specialized MPCT to assess pancreatic enhancement at the resection margin and its relation to the degree of fibrosis and risk of POPF. Methods: Between June 2012 and December 2013 all patients undergoing Whipple (PD), or distal (DP)/central pancreatectomy (CP) underwent