Pancreatic duct drainage/pancreaticojejunostomy/Puestow procedure
| Definition | pancreaticojejunostomy, involves a Roux-en-Y side-to-side anastomosis of the pancreatic duct and the jejunum. Usually for pancreatic carcinoma. Puestow procedure (most common), other is Duval. | ||
| Techniques | The abdomen is opened with an incision from the lower breastbone to the umbilicus. The pancreas is exposed and the main pancreatic duct is opened from the head to the tail of the pancreas. The opened pancreatic duct is then connected to a loop of small intestine so that the pancreas drains directly into the intestines.
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| Video | |||
| Choice of pt | symptomatic pancreatic ductal obstruction and a dilated main pancreatic duct. The main pancreatic duct needs to be 6mm in diameter in the body of the pancreas for this procedure to be possible. | ||
| Result | 80-90% have pain relief, but 5y post-op only 50% remain pain-free. mortality rate is about 3% pain can persist due to failure to drain the pancreatic duct on the head of the pancreas 5y post-op only 50% remain pain-free. Post-op hospital stay~ 7-14days | ||
| Complications | bleeding, infection, or an adverse reaction to anesthesia. Pancreatic leaks may also occur. |
Pancreatic resection- Whipple (pancreaticoduodenectomy)
| Definition | A surgical procedure in which the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the common bile duct are excised, usually to relieve obstruction caused by tumors, often malignant. Whipple procedure, named after the American surgeon Allen Whipple who devised a perfected version of the surgery in 1935  Steve Jobs, co-founder of Apple underwent Whipple’s procedure in 2004 |
| Techniques | Removal of the head of the pancreas, the duodenum, the distal bile duct, and occasionally a portion of the stomach. A reconstruction is performed that involves sewing the pancreas, bile duct and stomach to the small intestine. Takes anywhere from 3-5 hours to perform .  |
| Video | credit to Mr Adrian Cravioto |
| Choice of pt | disease is limited to the head of the pancrea patients with intractable pain and diffuse disease with nondilated ducts. |
| Result | pancreatic function and quality of life are impaired after these procedures, mortality rate of total pancreatectomy is about 10%. Pain is treated successfully in approximately 70% of cases Post-op hospital stay~ 7-14days |
| Complications | pancreatic fistula(12%) leakage from the pancreatic anastomosis, delayed gastric emptying. (20%)- may last 2-6 weeks Both complications are treated with intravenous hyperalimentation. |
Total Pancreatectomy
| Definition | surgical removal of the pancreas due to cancer or chronic pancreatitis |
| Techniques | Total pancreatectomy plus islet autotransplantation. This involves harvesting the islets from the resected pancreas and injecting them into the portal system, which then lodges them in the liver.  |
| Video | - |
| Choice of pt | pancreatic disease that involved the whole gland as well as intraductal pancreatic mucinous neoplasm, neuroendocrine tumors and pancreatic metastases from renal cell cancer. |
| Result | pain relief occurred in 82% (resolved in 39% and improved in 43% 51% were insulin independent initially, this decreased to 34% (one third) from 2-10 years after transplantation Poor prognosis- a patient would be on a lengthy regimen of medications and would be severely limited in his diet mortality rate 5-10% Post-op hospital stay~ 14-21days |
| Complications | bleeding, infection, or an adverse reaction to anesthesia. Leaks from areas of reattachment may also occur. |
1 comment:
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