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The surgery of chronic pancreatitis, pancreas The surgery of chronic pancreatitis, pancreas peseudocystspeseudocysts
Szentkereszty Zs. MD. PhD., Med. habil.
UD MHSC Inst. Of Surgery
Chronic pancreatitisChronic pancreatitis
1. Sclerosis of the pancreas
2. Gland atrophy - Focal
- segmental
- diffuse
Protein extraction – calcification
Duct dilatation– intraductal hypertension
LocalisationLocalisation
- Mosttly in the head of the pancreas( Guillemin, Traverso és Longmire, Beger)
- A „Rinnen” és „groove” pancreatitis-In the head
( Stolte, Becker)
- The predilective localisation of the tumours are also in the head of the pancreas
( Cubilla és Fitzgerald, Hertzberg, Nakase és mtsai, Spohn és mtsai)
EtiologyEtiology
- Alimentaion:fatty foods, abundant mealsalcoholism
- Developement of diagnosispancreas functional
testsimagies
ComplaintsComplaints
- Pain- Dypepsia- Weigh loss- Jaundice- Ascites- Duodenal obstraction- Diabetes
ImagiesImagies
- Gastrio-duodenal passage- Pancreas ultrasonography- Pancreas scintigraphy- CT, MRI- ERCP- MRCP
NORMAL ERCP VIEWNORMAL ERCP VIEW
VATER PAPILLA OBSTURCTIONVATER PAPILLA OBSTURCTION
„„CHAIN OF LAKES”CHAIN OF LAKES”
CALIBER IRREGULARITY, CALIBER IRREGULARITY, PSEUDOCYSPSEUDOCYS
PSEUDOCYS, CONNECTION WITH PSEUDOCYS, CONNECTION WITH THE PANCREATIC DUCTTHE PANCREATIC DUCT
PSEUDOCYSTPSEUDOCYST
PSEUDOCYST, SEGMENTAL PSEUDOCYST, SEGMENTAL DUCTECTASYDUCTECTASY
PSEUDOCYST IN THE HEADPSEUDOCYST IN THE HEAD
INDICATION OF SURGERY IN CHR. INDICATION OF SURGERY IN CHR. PANCREATITISPANCREATITIS
PainAcute exacerbationsComplications:
Jaundiceduodenal obstractionpseudocystspancreas
fistuleSuspition of cancer
x
SOME WORDS ABOUT THE SOME WORDS ABOUT THE SURGICAL TREATMENTSURGICAL TREATMENT
- It is symptomatic treatment
- The stop of etiology does not prevent the progression
- The alcohol free lifestyle is needed for the surgery
CHOICE OF TYPE OF THE SURGICAL CHOICE OF TYPE OF THE SURGICAL PROCEDUREPROCEDURE
The duct morphology is important
In general:
1. in case of dilatated duct decompressive surgery is needed
2. In cese of segmental, or focal inflammation resection is needed
Imagies:
US
CT
ERCP
MRCP
CHOICE OF SURGICAL PROCEDURES
- There is no generally used gold standard
- Organ save methods are better?
- The resections have a 5% of mortality rate
- The decompressive operations have lower rate of mortality
DRAINAGE OPERATIONS
- The drainage of the pancreatic juice- Decrease of the intraductal pressure
Types of decompressive operations
- longitudinal pancreaticojejunostomy- longitudinal pancreaticogastrostomy - Cyst drainage with the aboves- Pancreas head partzial resection and pancreat(ic)o-
jejunostomy
A LONGITUDINAL PANCREATO CYSTO-A LONGITUDINAL PANCREATO CYSTO-GASTROSTOMIAGASTROSTOMIA
RESECTIONSRESECTIONS
- Resection of the advanced local destruction- Resection of the duct destructions- Treatment of the local compresive complaints
Types of resectionsTypes of resections
- Whipple pancreatoduodenectomy- Pylorus – preserving pancreatoduodenectomy (PPPD)- Duodenum preserving pancreas head resection
PANCREAS-CYSTSPANCREAS-CYSTS
Definition true cyst
pseudocyst
Pathológic forms: 1. Genetic abnormalities
pl. fibrocystic pancreas, dermoid cyst
2. retentional cysts
3. parasitic cysts (hydatid)
4. neoplastic cysts
( cystadenoma, cystadenocarcinoma, teratoma)
5. pseudocysts
PANCREAS-CYSTSPANCREAS-CYSTS
PANCREAS-PSEUDOCYSTSPANCREAS-PSEUDOCYSTS
Localisation: pancreas headpancreas body pancreas tail
Complaint: dullnessPainduodenal obstruction
Diagnosis: USCT
Surgery: 1. decompression: cysto-duodenostomycysto-gastrostomycysto-jejunostomy2. resection3. External drainage4. Internal drainage (ERCP)
PANCREAS-PSEUDOCYSTSPANCREAS-PSEUDOCYSTS
Thank You for your attention!Thank You for your attention!