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The first experience laparoscopic proximal pancreatic resections in patients with chronic pancreatitis
Abstracts / Pancreatology 13 (2013) S2–S98
Introduction: Study the state of hypertriglyceridemia and its influence in the development of non-alcoholic fatty disease of the pancreas, chronic pancreatitis in obesity and coronary artery disease is importante in explaining the pathogenesis of these diseases and their comorbidity. Aims: To study the numbers of triglycerides in patients with chronic pancreatitis, depending on the duration of disease and age featuring. Patients & methods: Examined 43 patients with chronic pancreatitis, and 12 healthy volunteers, of which there were 27 men, women - 16. The groups were matched for sex, age, duration of disease. Studied the indicators of triglycerides by enzymatic method, using standard diagnostic kits by "Simko Ltd" company (Ukraine). Results: Analysis of the results showed that in healthy volunteers indicators of triglycerides was up to 1.7 mmol / l (1.430.04 mmol / l), with disease duration of 5 years (8 patients) showed a tendency to increase (p¼0.127), with disease duration of 10 years (23 patients) rates exceed the established threshold and amounted to 2.360.08 mmol/l. Increasing rates were observed in 5 patients, predominantly obese 1-2 degrees, older than 42 years. Insulin resistance observed in 11 patients (out of 23 in this group), 2 patients detected type 2 diabetes, comorbidity with coronary heart disease was detected in 7 people. Conclusion: Comorbidity of chronic pancreatitis, obesity and coronary heart disease increases hypertriglyceridemia, which is a risk factor for cardiovascular events in this group of patients and requires preventive measures.
PI-69 Abstract id: 334. Autoimmune pancreatitis associated with intraductal papillary musinous neoplasy (IPMN) Nevin Oruc 1, Oktay Tekesin 2, Murat Sozbilen 3, Funda Yilmaz 4, Ahmet Aydin 2, Mustafa Harman 5. 1
Ege Ege 3 Ege 4 Ege 5 Ege 2
University University University University University
S39
PI-70 Abstract id: 140. Organ-preserving surgery in patients with chronic pancreatitis Andrey Klimenko, Vladymyr Klymenko, Andrii Steshenko, Michael Sofilkanych, Dmytrii Syvolap. Zaporozhje State Medical University, Ukraine
Introduction: The use of resection surgery in patients with chronic pancreatitis (operations Beger, Frey pyloruspreserving pancreatoduodenal resection) is substantiates severe local morphological changes in the head of the pancreas. Aims: to prove the same types fibrous changes in the head, body and tail of the pancreas in chronic pancreatitis, which cause to pancreatic ductal hypertension. Patients & methods: In 59 patients with chronic pancreatitis was performed the developed organ-preserving operation. During the operation was carried out intake of the material for morphological studies at the same time from the head, body and tail of the pancreas. Histological and immunohistochemical methods were performed, and US, CT-scan, ERCP, intraoperative US, C-peptid, endogenous insulin, parathyroid hormone, CA - 19-9, Ig G, fecal elastase-1. Results: It was shown the same type of morphological changes in the head, body and tail of the pancreas: a significant in size periductal fibrosis with foci of immune-cells infiltration, formation of connective tissue` sheaths around the pancreatic ducts, penetration of a-SMA-positive stellate cells from periductal fibrosis in the area of interlobular stroma with the formation of fibrotic septa. In the long term (5 years) in patients abdominal pain ceased. The sizes of the pancreas head has turned to normal for 4 – 6 months, and was no worsening of the exocrine and endocrine insufficiency. Conclusion: Fibrous transformation of chronic pancreatitis is morphologically the same in all sections of the pancreas. Patients with chronic pancreatitis required organ-preserving type of operation with complete removal of ductal hypertension.
Gastroenterology, Turkey Gastroenterology, Turkey Surgery, Turkey Pathology, Turkey Radiology, Turkey
Introduction: Autoimmune pancreatitis is charecterised by chronic lymphoplasmocyte infiltration and fibrosis of the pancreas associated by high serum gammaglobulins especially serum IgG4. Autoimmune pancreatitis might lead suspicious pancreatic mass and can mimic pancreatic carcinoma. However there is no report about the association of IPMN and autoimmune pancreatitis. Aims: Here we report a case with autoimmune pancreatitis and IPMN. Patients & methods: Forty seven years old women was admitted to out patient clinic with abdominal pain for a year. Her evaluation showed elevated amylase and enlarged edematous pancreatic head. She was addmitted to inpatient clinic with prediagnosis of acute pancreatitis. Results: Radiological evaluation of the patient showed enlarged irregular pancreatic duct all along with enlarged side branches. Pancreatic parancyme was atrophic at tale of the pancreas. ERCP was performed and fish mouth papilla with thick musinous discharge was diagnostic for IPMN. EUS evaluation showed pancreatic IPMN as well as suspicious mass like lesion in the pancreatic head. Patient was operated with prediagnosis of IPMN and whiple procedure was performed. Histopathology revealed lymphoplasmocytic sclerosing chronic pancreatitis that is autoimmune pancreatitis and also cystic tumour in the pancreas relevant with IPMN. Conclusion: We reported an IPMN case developed in the background of autoimmune pancreatitis. This is the first case in the litherature with autoimmune pancreatitis and associated IPMN.The typical initial findings were suspicious for IPMN however histopathological evaluation showed autoimmune pancreatitis associated with IPMN.This case showed that autoimmune pancreatitis may mimic IPMN and in the background of autoimmune pancreatitis IPMN may develop.
PI-71 Abstract id: 98. The first experience laparoscopic proximal pancreatic resections in patients with chronic pancreatitis Aliaksandr Siatkouski. Vitebsk, Belarus Introduction: The using of laparoscopic access in treatment of chronic pancreatitis has to be explored. Aims: The first experience laparoscopic proximal pancreatic resections in treatment of chronic pancreatitis was analyzed. Patients & methods: 8 laparoscopic proximal pancreatic resections for chronic pancreatitis and its complications was performed in Vitebsk ^ 5. Regional Clinical Hospital. Women, 2, men 6. Mean age 40 A Results: Laparoscopic proximal pancreatic resections were performed in 8 cases: the Beger procedure without proximal pancreatoenterostomy (BwPPE) 2 and the Berne modification (BM) 6. Mean operating time was ^ ^ 330A88 minutes. Blood loss was 105A59 ml. Postoperative hospital stay ^ was 8A2 days. 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.
Introduction: Study the state of hypertriglyceridemia and its influence in the development of non-alcoholic fatty disease of the pancreas, chronic pancreatitis in obesity and coronary artery disease is importante in explaining the pathogenesis of these diseases and their comorbidity. Aims: To study the numbers of triglycerides in patients with chronic pancreatitis, depending on the duration of disease and age featuring. Patients & methods: Examined 43 patients with chronic pancreatitis, and 12 healthy volunteers, of which there were 27 men, women - 16. The groups were matched for sex, age, duration of disease. Studied the indicators of triglycerides by enzymatic method, using standard diagnostic kits by "Simko Ltd" company (Ukraine). Results: Analysis of the results showed that in healthy volunteers indicators of triglycerides was up to 1.7 mmol / l (1.430.04 mmol / l), with disease duration of 5 years (8 patients) showed a tendency to increase (p¼0.127), with disease duration of 10 years (23 patients) rates exceed the established threshold and amounted to 2.360.08 mmol/l. Increasing rates were observed in 5 patients, predominantly obese 1-2 degrees, older than 42 years. Insulin resistance observed in 11 patients (out of 23 in this group), 2 patients detected type 2 diabetes, comorbidity with coronary heart disease was detected in 7 people. Conclusion: Comorbidity of chronic pancreatitis, obesity and coronary heart disease increases hypertriglyceridemia, which is a risk factor for cardiovascular events in this group of patients and requires preventive measures.
PI-69 Abstract id: 334. Autoimmune pancreatitis associated with intraductal papillary musinous neoplasy (IPMN) Nevin Oruc 1, Oktay Tekesin 2, Murat Sozbilen 3, Funda Yilmaz 4, Ahmet Aydin 2, Mustafa Harman 5. 1
Ege Ege 3 Ege 4 Ege 5 Ege 2
University University University University University
S39
PI-70 Abstract id: 140. Organ-preserving surgery in patients with chronic pancreatitis Andrey Klimenko, Vladymyr Klymenko, Andrii Steshenko, Michael Sofilkanych, Dmytrii Syvolap. Zaporozhje State Medical University, Ukraine
Introduction: The use of resection surgery in patients with chronic pancreatitis (operations Beger, Frey pyloruspreserving pancreatoduodenal resection) is substantiates severe local morphological changes in the head of the pancreas. Aims: to prove the same types fibrous changes in the head, body and tail of the pancreas in chronic pancreatitis, which cause to pancreatic ductal hypertension. Patients & methods: In 59 patients with chronic pancreatitis was performed the developed organ-preserving operation. During the operation was carried out intake of the material for morphological studies at the same time from the head, body and tail of the pancreas. Histological and immunohistochemical methods were performed, and US, CT-scan, ERCP, intraoperative US, C-peptid, endogenous insulin, parathyroid hormone, CA - 19-9, Ig G, fecal elastase-1. Results: It was shown the same type of morphological changes in the head, body and tail of the pancreas: a significant in size periductal fibrosis with foci of immune-cells infiltration, formation of connective tissue` sheaths around the pancreatic ducts, penetration of a-SMA-positive stellate cells from periductal fibrosis in the area of interlobular stroma with the formation of fibrotic septa. In the long term (5 years) in patients abdominal pain ceased. The sizes of the pancreas head has turned to normal for 4 – 6 months, and was no worsening of the exocrine and endocrine insufficiency. Conclusion: Fibrous transformation of chronic pancreatitis is morphologically the same in all sections of the pancreas. Patients with chronic pancreatitis required organ-preserving type of operation with complete removal of ductal hypertension.
Gastroenterology, Turkey Gastroenterology, Turkey Surgery, Turkey Pathology, Turkey Radiology, Turkey
Introduction: Autoimmune pancreatitis is charecterised by chronic lymphoplasmocyte infiltration and fibrosis of the pancreas associated by high serum gammaglobulins especially serum IgG4. Autoimmune pancreatitis might lead suspicious pancreatic mass and can mimic pancreatic carcinoma. However there is no report about the association of IPMN and autoimmune pancreatitis. Aims: Here we report a case with autoimmune pancreatitis and IPMN. Patients & methods: Forty seven years old women was admitted to out patient clinic with abdominal pain for a year. Her evaluation showed elevated amylase and enlarged edematous pancreatic head. She was addmitted to inpatient clinic with prediagnosis of acute pancreatitis. Results: Radiological evaluation of the patient showed enlarged irregular pancreatic duct all along with enlarged side branches. Pancreatic parancyme was atrophic at tale of the pancreas. ERCP was performed and fish mouth papilla with thick musinous discharge was diagnostic for IPMN. EUS evaluation showed pancreatic IPMN as well as suspicious mass like lesion in the pancreatic head. Patient was operated with prediagnosis of IPMN and whiple procedure was performed. Histopathology revealed lymphoplasmocytic sclerosing chronic pancreatitis that is autoimmune pancreatitis and also cystic tumour in the pancreas relevant with IPMN. Conclusion: We reported an IPMN case developed in the background of autoimmune pancreatitis. This is the first case in the litherature with autoimmune pancreatitis and associated IPMN.The typical initial findings were suspicious for IPMN however histopathological evaluation showed autoimmune pancreatitis associated with IPMN.This case showed that autoimmune pancreatitis may mimic IPMN and in the background of autoimmune pancreatitis IPMN may develop.
PI-71 Abstract id: 98. The first experience laparoscopic proximal pancreatic resections in patients with chronic pancreatitis Aliaksandr Siatkouski. Vitebsk, Belarus Introduction: The using of laparoscopic access in treatment of chronic pancreatitis has to be explored. Aims: The first experience laparoscopic proximal pancreatic resections in treatment of chronic pancreatitis was analyzed. Patients & methods: 8 laparoscopic proximal pancreatic resections for chronic pancreatitis and its complications was performed in Vitebsk ^ 5. Regional Clinical Hospital. Women, 2, men 6. Mean age 40 A Results: Laparoscopic proximal pancreatic resections were performed in 8 cases: the Beger procedure without proximal pancreatoenterostomy (BwPPE) 2 and the Berne modification (BM) 6. Mean operating time was ^ ^ 330A88 minutes. Blood loss was 105A59 ml. Postoperative hospital stay ^ was 8A2 days. 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.