Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2011 Vol. 19 No 3

GENERAL AND SPECIAL SURGERY

SHCHASTNY A.T.

POSTOPERATIVE COMPLICATIONS OF THE PROXIMAL PANCREAS RESECTIONS IN PATIENTS WITH CHRONIC PANCREATITIS

Objectives. To work out tactical and technical recommendations concerning complication prevention of proximal resection of the pancreas.
Methods. Retrospective investigation of the results of 22 pancreas proximal resection was carried out. 102 (45,7%) duodenum-saving proximal resections the pancreas head on Beger were done. Berns modification of Beger operation was done in 46 (20,6%) patients. Frey operation was done in 13 (5,8%) patients. Pancreatoduodenal resection was performedin 62 (27,8%) patients, from them in 41 patients a pylori-saving variant was used.
Results. Postoperative lethality composed 3,1%; postoperative complications incidence composed 3, 8%. The greatest share of early postoperative complications was in the postoperative pancreatitis 15 (21,1%) patients; insufficiency of various forms of anastomoses - in 14 (20%) and pancreatic fistulas in 14 (20) cases. Bile outflow was diagnosed in 8,5% cases. Intra-abdominal hemorrhages and bleedings in the intestinal lumen composed 8,5%
Conclusions. Duodenum-saving techniques permit to obtain low parameters of the postoperative complications and lethality. Mini-invasive interventions allow eliminating adequately the postoperative complications without repeated operations in the majority of operated patients. It is necessary to concentrate patients with chronic pancreatitis in large medical institutions, employing surgeons-pancreatologists.

Keywords: chronic pancreatitis, proximal resection, postoperative complications, pancreato-digestive anastomosis
p. 30 43 of the original issue
References
  1. Pancreatic head resection: the risk for local and systemic complications in 1315 patients a monoinstitutional experience / H. G. Beger [et al.] // Am. J. Surg. 2007. Vol. 194. P. S16-S19.
  2. Changes in mortality after pancreatic resection: towards the end of completion pancreatectomy / M. W. Buchler [et al.] // Arch. Surg. 2003. Vol. 138. P. 1310-1314.
  3. Frey, C. F. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure) / C. F. Frey, L. M. Kathrin // World J. Surg. 2003. Vol. 27. P. 1217-1230.
  4. Bruns, C. J. Surgical treatment of pancreatic cancer / C. J. Bruns, K. W. Jauch // Dtsch. Med. Wochenschr. 2007. Vol. 132. P. 798-802.
  5. Pancreac Cancer Resection Outcome in Fmerican University Centers in 1989-1990 / S. B. Edge [et al.] // Cancer. 1993. Vol. 71, N 11. P. 3502-3508.
  6. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy: review and statistical meta-analysis regarding 15 years of literature / F. G. Bartoli [et al.] // Anticancer Res. 1991. Vol. 11. P. 1831-1848.
  7. Comparison of Wirsung-jejunal duct-to-mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy / G. Batignani [et al.] // Hepatobiliary Pancreat. Dis. Int. 2005. Vol. 4. P. 450-455.
  8. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy / A. McKay [et al.] // Br. J. Surg. 2006. Vol. 93. P. 929-936.
  9. Prevention and treatment of complications in pancreatic cancer surgery / P. O. Berberat [et al.] // Dig. Surg. 1999. Vol. 16. P. 327-336.
  10. Pancreatic fistula after pancreatic head resection / M. W. Buchler [et al.] // BJS. 2000. Vol. 87. P. 883-889.
  11. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality / J. L. Cameron [et al.] // Ann. Surg. 1993. Vol. 217. P. 430-435. Disc. 435-8.
  12. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS)definition / M. N. Wente [et al.] // Surgery. 2007. Vol. 142. P. 20-25.
  13. Management of delayed visceral arterial bleeding after pancreatic head resection / F. Makowiec [et al.] // J. Gastrointest. Surg. 2005. Vol. 9. P. 1293-1299.
  14. Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery / Y. Yamashita [et al.] // Am. J. Surg. 2007. Vol. 193. P. 454-459.
  15. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS) / M. N. Wente [et al.] // Surgery. 2007. Vol. 142. P. 761-768.
  16. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome / C. J. Yeo [et al.] // Ann. Surg. 1999. Vol. 229. P. 613-622. Disc. 622-4.
  17. Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery / S. Connor [et al.] // Br. J. Surg. 2005. Vol. 92. P. 1059-1067.
  18. Prevention of pancreaticojejunal anastomotic leakage after pancreaticoduodenectomy with separate internal drainage of bile and pancreatic fluid / X. W. Dai [et al.] // Hepatobiliary Pancreat. Dis. Int. 2003. Vol. 2. P. 131-134.
  19. A prospective analysis of factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies / S. Matsusue [et al.] // Surg. Today. 1998. Vol. 28. P. 719-726.
  20. Pancreatic anastomoses after pancreatico-duodenectomy: do we need further studies? / S. V. Shrikhande [et al.] // World J. Surg. 2005. Vol. 29. - P. 1642-1649.
  21. , . . / . . , . . . .: , 2007. 448 c.
  22. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy / J. P. Duffas [et al.] // Am. J. Surg. 2005. Vol. 189. P. 720-729.
  23. Duct-to-mucosa versus end-to-side pancreatico-jejunostomy reconstruction after pancreatico-duodenectomy: results of a prospective randomized trial / C. Bassi [et al.] // Surgery. 2003. Vol. 134. P. 766-771.
  24. Postoperative pancreatic fistula: an international study group (ISGPF) definition / C. Bassi [et al.] // Surgery. 2005. Vol. 138. P. 8-13.
  25. , . . / . . , . . . .: , 2003. 386 .
  26. Hemorrhage after duodenopancreatectomy: impact of neoadjuvant radiochemotherapy and experience with sentinel bleeding / O. Turrini [et al.] // World J. Surg. 2005. Vol. 29. P. 212-216.
  27. Kurosaki, I. Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy / I. Kurosaki, K. Hatakeyama // Int. Surg. 2004. Vol. 89. P. 90-94.
  28. Schafer, M. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis / M. Schafer, B. Mullhaupt, P. A. Clavien // Ann. Surg. 2002. Vol. 236, N 2. P. 137-148.
Contacts | ©Vitebsk State Medical University, 2007