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Laparoscopic interventions in patients with chronic pancreatitis
Abstracts / Pancreatology 12 (2012) 502–597
522
Objectives: Current applications of laparoscopic approaches to left pancreatectomy, tumor enucleation, and pancreaticoduodenectomy for treatment of pancreatic tumors are considered in the available evidence demonstrating feasible and safety. Patients: Laparoscopic distal pancreatectomy (LDP) 5cases (MCN3, IPMN1, Insulinoma1), pancreaticoduodenedctomy (LPD) 1case (Cancer of the Papilla), and tumor enucleation 1case (Insulinoma) are performed. Result: (1) MCN: The mean age of the 3 patients was 34.3 years, and were all women. The mean operative time, blood loss and hospital stay were 330min, 122ml, 8.6days. (2)IPMN: A 76-years-old women had the F40mm tumor of the tail of the pancreas. The operative time, blood loss and hospital stay were 295min, 100ml, 8days. (3) Insulinoma: LPD; A 63years-old man had the F15mm tumor of the body of the pancreas. The operative time, blood loss and hospital stay were 440min, 200ml, 6days. Tumor enucleation; A 27-years-old man had the F17mm tumor of the body of the pancreas. The operative time, blood loss and hospital stay were 202min, A little, 7days. (4) Cancer of the Papilla: A 72-years-old woman had the T2 tumor with no involvement of lymph nodes. The operative time, blood loss and hospital stay were 558min, 70ml, 20days. Conclusion: Laparoscopic pancreatic surgery can be performed safely and effectively in patients with benign or low-grade malignant neoplasms of the pancreas.
P71.
P73.
A prospective non-randomised study, comparing Frey procedure with pylorus-preserving pancreatoduodenectomy in the treatment of chronic pancreatitis 1
S.I. Tretyak , S.M. Rashchynski 1 2
Patients and methods: In our clinic there were 26 laparoscopic interventions was performed for chronic pancreatitis and its complications. Results: Laparoscopic interventions were performed in 26 cases: cystogastrostomy 6, cystoduodenostomy 3, cystojejunostomy 8, cystectomy 1, longitudinal laparoscopic pancreaticojejunostomy 8. In all the cases of laparoscopic procedures the communication of a cyst with the main pancreatic duct were confirmed by preoperative biochemical and cytologic analysis of cystic fluid taken under the ultrasound control puncture. In the patient with a cyst located in the tail of the pancreas, the bleeding from the splenic artery required to convert the operation into open. In another patient laparoscopic longitudinal pancreatovirsungotomy and pancreatic resection were performed due to the impossibility of adequate cyst drainage in the hamulus region of the pancreas which required conversion of the operation into open. All patients who underwent minimally invasive procedures were discharged on the 6th day without any postoperative complications. Conclusion: Clinical experience in the use of laparoscopic procedures in chronic pancreatitis treatment supports the conclusions of other authors concerning the advantages of laparoscopic techniques which are of better tolerance and which shorten hospital stay. The application of minimally invasive surgery techniques may be effective on condition that there is a thorough selection of patients taking into account the anatomic features of the pancreas and its duct system in every individual case.
1, 2
2
, N.T. Rashchinskaya .
Belarusian State Medical University, Minsk, Belarus Hospital of Emergency Medical Care, Minsk, Belarus
Introduction: Resection and drainage are the two basic surgical principles in surgical treatment of chronic pancreatitis (CP). Aims/objectives: The aim of this prospective study was to compare two surgical procedures in the treatment for CP: pylorus-preserving pancreatoduodenectomy (PPPD) to Frey's procedure (FP), to define the advantages of each procedure with regard to postoperative complications, pain relief, and the quality of life. Patients and methods: 58 consecutive patients were included into this study. PPPD was chosen when the head pancreatic mass was present or pancreatic cancer could not be ruled out (21 patients); otherwise FP was performed (37 cases). Early postoperative morbidity and mortality were assessed and evaluated in both groups of patients. Quality of life was measured prospectively before surgery and during follow-up (median 12 – 15 months) using the SF-36 v.2Ô Health Survey Questions (Russian version). Results: In the immediate postoperative period more complications were observed in the PPPD-group (a<0.05). Total pain score decreased and quality of life increased significantly after surgery in both groups of patients, but the differences were not significant. Conclusion: Both surgical procedures led to significant improvement in the quality of life and pain relief after surgery for CP. Under equal conditions, the preference should be given to FP, as more safe operation by results in the early postoperative period.
Double drainage at treatment of large pseudo cysts of the pancreas S. Lyarski, A. Siatkouski, A. Shchastny, M. Kuhaeu. The Vitebsk State Medical University, Vitebsk, Belarus Objectives: Improved results of surgical treatment of patients with pancreatic pseudocysts larger (more than 10 cm in diameter) using the internal “double drain” Methods: 68 patients with pseudocysts of more than 10 cm in diameter were operated on. In 14 (23,3%) patients the method of double drainage was applied. Method of treatment of large pancreatic pseudocysts includes external-internal drainage of the cyst through the stomach or duodenum, and an additional cistojejunoanastamos. Transnasal through these anastomoses in the cavity of the cyst drainage is carried out. After surgery, cyst cavity was washed through the drainage tube, control the volume ofdischarge from the cavity of the cyst. At 4–5 days after surgery performed X-ray. With a decrease in the cyst cavity and a good evacuation, drainage removed. At 10 - 12 days after surgery to perform ultrasonography - study. The results of treatment were analyzed for the following indicators: postoperative complications, mortality, duration of treatment. Results: In 2 patients for 2-3 days spontaneously evacuated drainage and control X-ray examination was not performed. After applying the method of dual drainage of pseudocysts, postoperative complications and deaths was not observed. Periods of observation from 1 to 4 years. Recurrence of the disease has been not identified. In our work, we identified the indications and contraindications for the implementation of the method of double drainage of large cysts of the pancreas. Conclusions: The usage of the suggested technique of the surgical intervention permits to decrease the number of the postoperative complications and to improve the treatment results of large postnecrotic pseudocysts.
P72. Laparoscopic interventions in patients with chronic pancreatitis
P74.
A. Siatkouski, A. Shchastny, M. Kuhaeu, S. Lyarski.
Distant results of the pancreas proximal resection in patients with chronic pancreatitis
The Vitebsk State Medical University, Vitebsk, Belarus Background: The usefulness of laparoscopic access in treatment of chronic pancreatitis has to be explored. Objective: the analysis of laparoscopic operations in treatment of chronic pancreatitis.
A. Shchastny, A. Siatkouski, M. Kuhaeu, S. Lyarski. The Vitebsk State Medical University, Vitebsk, Belarus Objectives: To analyze distant results of the pancreas proximal resection and to study the quality of patients, life in the postoperative period
522
Objectives: Current applications of laparoscopic approaches to left pancreatectomy, tumor enucleation, and pancreaticoduodenectomy for treatment of pancreatic tumors are considered in the available evidence demonstrating feasible and safety. Patients: Laparoscopic distal pancreatectomy (LDP) 5cases (MCN3, IPMN1, Insulinoma1), pancreaticoduodenedctomy (LPD) 1case (Cancer of the Papilla), and tumor enucleation 1case (Insulinoma) are performed. Result: (1) MCN: The mean age of the 3 patients was 34.3 years, and were all women. The mean operative time, blood loss and hospital stay were 330min, 122ml, 8.6days. (2)IPMN: A 76-years-old women had the F40mm tumor of the tail of the pancreas. The operative time, blood loss and hospital stay were 295min, 100ml, 8days. (3) Insulinoma: LPD; A 63years-old man had the F15mm tumor of the body of the pancreas. The operative time, blood loss and hospital stay were 440min, 200ml, 6days. Tumor enucleation; A 27-years-old man had the F17mm tumor of the body of the pancreas. The operative time, blood loss and hospital stay were 202min, A little, 7days. (4) Cancer of the Papilla: A 72-years-old woman had the T2 tumor with no involvement of lymph nodes. The operative time, blood loss and hospital stay were 558min, 70ml, 20days. Conclusion: Laparoscopic pancreatic surgery can be performed safely and effectively in patients with benign or low-grade malignant neoplasms of the pancreas.
P71.
P73.
A prospective non-randomised study, comparing Frey procedure with pylorus-preserving pancreatoduodenectomy in the treatment of chronic pancreatitis 1
S.I. Tretyak , S.M. Rashchynski 1 2
Patients and methods: In our clinic there were 26 laparoscopic interventions was performed for chronic pancreatitis and its complications. Results: Laparoscopic interventions were performed in 26 cases: cystogastrostomy 6, cystoduodenostomy 3, cystojejunostomy 8, cystectomy 1, longitudinal laparoscopic pancreaticojejunostomy 8. In all the cases of laparoscopic procedures the communication of a cyst with the main pancreatic duct were confirmed by preoperative biochemical and cytologic analysis of cystic fluid taken under the ultrasound control puncture. In the patient with a cyst located in the tail of the pancreas, the bleeding from the splenic artery required to convert the operation into open. In another patient laparoscopic longitudinal pancreatovirsungotomy and pancreatic resection were performed due to the impossibility of adequate cyst drainage in the hamulus region of the pancreas which required conversion of the operation into open. All patients who underwent minimally invasive procedures were discharged on the 6th day without any postoperative complications. Conclusion: Clinical experience in the use of laparoscopic procedures in chronic pancreatitis treatment supports the conclusions of other authors concerning the advantages of laparoscopic techniques which are of better tolerance and which shorten hospital stay. The application of minimally invasive surgery techniques may be effective on condition that there is a thorough selection of patients taking into account the anatomic features of the pancreas and its duct system in every individual case.
1, 2
2
, N.T. Rashchinskaya .
Belarusian State Medical University, Minsk, Belarus Hospital of Emergency Medical Care, Minsk, Belarus
Introduction: Resection and drainage are the two basic surgical principles in surgical treatment of chronic pancreatitis (CP). Aims/objectives: The aim of this prospective study was to compare two surgical procedures in the treatment for CP: pylorus-preserving pancreatoduodenectomy (PPPD) to Frey's procedure (FP), to define the advantages of each procedure with regard to postoperative complications, pain relief, and the quality of life. Patients and methods: 58 consecutive patients were included into this study. PPPD was chosen when the head pancreatic mass was present or pancreatic cancer could not be ruled out (21 patients); otherwise FP was performed (37 cases). Early postoperative morbidity and mortality were assessed and evaluated in both groups of patients. Quality of life was measured prospectively before surgery and during follow-up (median 12 – 15 months) using the SF-36 v.2Ô Health Survey Questions (Russian version). Results: In the immediate postoperative period more complications were observed in the PPPD-group (a<0.05). Total pain score decreased and quality of life increased significantly after surgery in both groups of patients, but the differences were not significant. Conclusion: Both surgical procedures led to significant improvement in the quality of life and pain relief after surgery for CP. Under equal conditions, the preference should be given to FP, as more safe operation by results in the early postoperative period.
Double drainage at treatment of large pseudo cysts of the pancreas S. Lyarski, A. Siatkouski, A. Shchastny, M. Kuhaeu. The Vitebsk State Medical University, Vitebsk, Belarus Objectives: Improved results of surgical treatment of patients with pancreatic pseudocysts larger (more than 10 cm in diameter) using the internal “double drain” Methods: 68 patients with pseudocysts of more than 10 cm in diameter were operated on. In 14 (23,3%) patients the method of double drainage was applied. Method of treatment of large pancreatic pseudocysts includes external-internal drainage of the cyst through the stomach or duodenum, and an additional cistojejunoanastamos. Transnasal through these anastomoses in the cavity of the cyst drainage is carried out. After surgery, cyst cavity was washed through the drainage tube, control the volume ofdischarge from the cavity of the cyst. At 4–5 days after surgery performed X-ray. With a decrease in the cyst cavity and a good evacuation, drainage removed. At 10 - 12 days after surgery to perform ultrasonography - study. The results of treatment were analyzed for the following indicators: postoperative complications, mortality, duration of treatment. Results: In 2 patients for 2-3 days spontaneously evacuated drainage and control X-ray examination was not performed. After applying the method of dual drainage of pseudocysts, postoperative complications and deaths was not observed. Periods of observation from 1 to 4 years. Recurrence of the disease has been not identified. In our work, we identified the indications and contraindications for the implementation of the method of double drainage of large cysts of the pancreas. Conclusions: The usage of the suggested technique of the surgical intervention permits to decrease the number of the postoperative complications and to improve the treatment results of large postnecrotic pseudocysts.
P72. Laparoscopic interventions in patients with chronic pancreatitis
P74.
A. Siatkouski, A. Shchastny, M. Kuhaeu, S. Lyarski.
Distant results of the pancreas proximal resection in patients with chronic pancreatitis
The Vitebsk State Medical University, Vitebsk, Belarus Background: The usefulness of laparoscopic access in treatment of chronic pancreatitis has to be explored. Objective: the analysis of laparoscopic operations in treatment of chronic pancreatitis.
A. Shchastny, A. Siatkouski, M. Kuhaeu, S. Lyarski. The Vitebsk State Medical University, Vitebsk, Belarus Objectives: To analyze distant results of the pancreas proximal resection and to study the quality of patients, life in the postoperative period