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PubMed1988

The effect of pancreatectomy and gastroenterectomy on the release of somatostatin and vasoactive intestinal polypeptide in experimental fecal peritonitis.

Rats were subjected to laparotomy, to pancreatectomy, to gastroenterectomy (control groups), or to these procedures plus a septic challenge by instillation of 0.1 ml feces intraperitoneally (experimental groups). In the laparotomized controls plasma somatostatin values were significantly higher in samples from the portal vein than from the upper inferior caval vein. After both pancreatectomy and gastroenterectomy a significant fall in plasma somatostatin values was observed, and there was no significant difference between samples taken from the portal vein and the systemic circulation. An intraperitoneal septic challenge elicited a significant rise in portal plasma somatostatin in laparotomized rats, whereas this increase did not occur in pancreatectomized and gastroenterectomized animals, supporting the notion that plasma somatostatin originates from the pancreas and/or the gastrointestinal tract during septic peritonitis. No differences were detected in plasma vasoactive intestinal polypeptide (VIP) values in animals from the three control groups. However, both in laparotomized and in pancreatectomized septic animals a significant rise in plasma VIP was demonstrated in samples from the portal vein. By contrast, no such increase was observed in gastroenterectomized septic rats. Thus, the gastrointestinal tract seems to be the major source of circulating VIP during fecal peritonitis in the rat.

Animals↗

PubMed1990

Reduced insulin secretion by subtotal pancreatectomy: preservation of insulin sensitivity and glucose tolerance in postoperative patients.

This study investigated insulin sensitivity and glucose tolerance after subtotal pancreatectomy for carcinoma of the head of the pancreas. Twelve consecutive, non-diabetic patients were studied after potentially curative surgery at which the distal pancreas was stapled off, leaving approximately 15% of the pancreas in situ. Brief infusions of insulin (10 mU kg-1) and glucose (25 g) were given before and 4 days after operation. Postoperatively, blood glucose levels remained unchanged, whereas fasting levels of insulin. C-peptide, and pancreatic glucagon were decreased, although significantly (p less than 0.01) only for glucagon. The early and late phases of the insulin and C-peptide responses to glucose were severely reduced. Notably, the hypoglycemic action of insulin and the glucose tolerance were similar to those observed before operation. It is concluded that an acute reduction in pancreatic mass does not impair insulin action or glucose tolerance shortly after surgery. This contrasts with the insulin resistance and glucose intolerance seen shortly after pancreas-preserving intra-abdominal procedures of similar size. It is suggested that the decrease in glucagon levels is at least partly responsible for the preservation of insulin action after subtotal pancreatectomy.

Aged↗

PubMedDate not supplied

Early effects of standard and pylorus-preserving pancreatectomy on myoelectric activity and gastric emptying.

BACKGROUND/AIMS: The main concern about pylorus preserving pancreatectomy (PPP) is delayed gastric emptying (GE). Both cancer and surgical procedures cause damage to the enteric nervous system and induce profound changes in gastric motility and emptying. The aim was to evaluate the effects of primary disease and type of surgical procedure used (standard pancreatoduodenectomy, SP vs. PPP) on myoelectric activity (MA), and solid and liquid GE in pancreatectomy patients. METHODOLOGY: Twenty-eight subjects were included, 18 after Whipple (group A) and 10 after a Traverso (group B) procedure. MA was captured by cutaneous electrodes (Synectics) and simultaneously LGE tested with ultrasonography. On separate days, the SGE of a radiolabelled meal was measured. MA and GE studies were done before and within three months after surgery. RESULTS: Before surgery LGE/SGE were delayed in 5/8 patients in group A and 2/2 in group B. Gastric dysrhythmia was observed in 6 patients in group A and 1 in group B. After PPP, the nasogastric tube was removed within 8.4+/-4.9 days and after SP within 4.6+/-4.1 days. GE studies showed accelerated LGE/SLG in 16/12 and delayed in 6/5 patients, respectively, in group A and B. Dysrhythmia was observed in 16 patients in group A and in 4 in group B. There was a strong relationship between SGE delay and dysrhythmia in patients after PPP. CONCLUSIONS: We conclude that papilla of Vater neoplasia damages mechanisms responsible for gastric emptying to a lesser extent than pancreatic cancer. In patients after PPP, post-operative MA disturbances are partially responsible for delayed GE.

Adolescent↗

PubMed1999

Laparoscopic distal pancreatectomy with preservation of the spleen.

We describe a case of chronic pancreatitis treated by laparoscopic distal pancreatectomy with conservation of the spleen involving the resection of the splenic vessels. A proximal ligation of the splenic artery and vein was performed, followed by transection of the body of the pancreas. Retroperitoneum was dissected to the left by mobilizing the stump of the transected pancreas. The entire distal pancreas was freed posteriorly. The distal splenic artery and vein were ligated and divided individually adjacent to the tail of the pancreas at the hilum of the spleen. The points of this operation were to ligate the splenic artery and vein at both sides of the resected pancreas and to save the spleen with the blood supply continuing through the short gastric vessels and the splenocolic ligament. This operation with splenic preservation is more suitable for a patient who is a candidate for laparoscopic distal pancreatectomy, which will minimize the operation time, preserve the useful immunologic role of the spleen, and obtain the intact resected specimen. Furthermore, this procedure is useful in chronic pancreatitis patients because it avoids the difficult dissection of the posterior pancreas off of the splenic vessels.

Aged↗

PubMed1975

Persistent neonatal hypoglycaemia. A clinical and histopathological study of three cases treated with diazoxide and subtotal pancreatectomy.

Two boys and one girl developed persisting hypoglycaemia 12, 24, and 48 hours after birth. Although there was no known history of hereditary diabetes mellitus, the birth weight was high in two cases, and some additional traits of foetopathia diabetica could not be excluded clinically. All had high serum insulin levels with frank hyperinsulinaemia in one case. Glucose tolerance tests also indicated hyperinsulinism. Diazoxide (8 to 27 mg/kg) elevated the blood glucose levels, but did not prevent severe hypoglycaemic episodes. The effects of subtotal pancreatectomy were only transient. The patients have now been kept on permanent diazoxide therapy for 2-4 years at dosages slightly lower than those used before operation. No islet-cell tumour was found at the subtotal pancreatectomy. In all 3 cases, the pancreatic islets were markedly hyperplastic and of irregular shape with the occurrence of large B-cells with giant hyperchromatic nuclei and chromophobe "agranular" or sparsely granulated cells. The predominating kind of islet cells showed tinctorial features of A2-cells but--in the absence of available material set aside for ultrastructural analysis--it could not be settled whether this was a result of a proliferation of A2-cells only or of "type IV cells" as well. Against the background of previously published reports, the present cases serve to illustrate that additional accuracy of diagnosis and classification of neonatal persistent hypoglycaemia requires quantitative information about the structural changes in the pancreatic islet cells, and that this can be obtained from conventional biopsy specimens.

Biopsy↗

PubMedDate not supplied

Complete drainage of pancreatic juice from the cut edge of the pancreas after subtotal left-side pancreatectomy.

The management of the cut stump after a subtotal left-side pancreatectomy is sometimes difficult compared with that after distal pancreatic resection, which is performed at or to the left of the superior mesenteric vein. This report describes a simple and effective drainage method of leaking pancreatic juice from the cut stump after subtotal left-side pancreatectomy for pancreatic adenocarcinoma located in the body and tail. Since July 20, 1994, we have applied this method to 12 patients with carcinoma of the body and tail of the pancreas other than the present case and as yet have never experienced serious postoperative complications.

Adenocarcinoma↗

PubMedDate not supplied

Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer.

BACKGROUND/AIMS: To assess preliminary results of preoperative embolization of the common hepatic artery in preparation for distal pancreatectomy with en bloc resection of the celiac and common hepatic arteries for carcinoma of the body of the pancreas involving these arteries. METHODOLOGY: Four patients underwent the embolization with coils 1-7 (median: 5) days before surgery. A detachable coil was used to obtain the best position of the first coil as an anchor in 3 patients. RESULTS: Immediately after embolization, collateral pathways developed from the superior mesenteric artery via the pancreatoduodenal arcades to the proper hepatic and gastroduodenal arteries in all 4 patients; however, they were relatively poor in one patient. There were no complications after embolization. The pulsation of the proper hepatic and gastroduodenal arteries was well palpable during surgery, although it had been compromised sometimes in previous cases without embolization. There were no ischemia-related complications in the 2 patients who underwent radical surgery. CONCLUSIONS: Preoperative embolization of the common hepatic artery is a safe technique and has the potential to enlarge the collateral pathways by the time of distal pancreatectomy with en bloc resection of the celiac artery and prevent postoperative fatal ischemia-related complications.

Aged↗

PubMedDate not supplied

Spleen-preserving laparoscopic distal pancreatectomy for cystic adenoma.

For borderline malignant diseases of the pancreas such as cystic adenoma, partial pancreatectomy or pancreatoduodenectomy including pylorus-preserving pancreaticoduodenectomy have been performed depending on tumor location under large median laparotomy. To investigate the feasibility of a technique with minimal skin incision, while retaining safety equivalent to conventional resection of the pancreatic tail, by making use of the advantages of laparoscopic procedure, we performed a minimally invasive laparoscopic resection of the pancreatic tail with preservation of the spleen. A 69-year-old woman underwent surgery for a diagnostic therapy for a cystic lesion of the pancreatic tail. The procedure was performed as follows: All procedures were performed completely laparoscopically under CO2 insufflation. After dissection of the omentum, laparoscopic ultrasound was performed to identify the location of the tumor and splenic vessels. The splenic hilus was dissected with preservation of the splenocolic ligament to maintain the lower blood supply to the spleen. The left gastroepiploic artery and the short gastric arteries and veins could be preserved. After division of the splenic hilus, the splenic artery and vein were identified from behind the pancreas by being held up and dissected individually by intracorporeal ligation by 3-0 Nylon. Then, pancreatic transection was performed 1 cm proximal to the tumor with the Endo-GIAII. The duration of operation was 4.5 hours. Intraoperative blood loss was under 50 mL. Histological examination revealed mucinous cytadenoma. She could walk the day after surgery and was discharged from the hospital uneventfully. CT prior to discharge from the hospital revealed sufficient blood flow in the spleen. Thus, it may be feasible to select laparoscopic spleen-preserving distal pancreatectomy as a first choice for diagnostic therapy for cystic lesions of the pancreatic tail.

Aged↗

PubMedDate not supplied

Is there any benefit of preservation of the spleen in distal pancreatectomy?

For a pancreatic body or tail tumor, distal pancreatectomy with splenectomy (DPS) is a standard operation. Spleen-preserving distal pancreatectomy (SPDP) was introduced in order to preserve the organ and thus provide the patient with a better quality of life. Clinical data were compared between 38 Japanese patients with DPS and 9 with SPDP for benign tumors or tumor-like lesions at the body or tail of the pancreas at preoperative, early postoperative (< 3 months after operation), and late postoperative periods (>6 months after operation). The preoperative findings were not different between the two groups except for the significantly higher serum amylase levels in the SPDP group. Operation time, operative blood loss, and length of postoperative hospital stay were not different between the two groups. Pancreatic fistula occurred in 3 (8%) of the 38 patients in the DPS group and in 1 (11%) of the 9 patients in the SPDP group, abdominal abscess in 5 (13%) of the 38 patients in the DPS group and none (0%) in the 9 patients in the SPDP group. At short-term, clinical findings were not different between the two groups except for a significantly greater platelet count in the DPS group than in the SPDP group (46.8 x 10(4)/microl versus 29.6 x 10(4)/microl, P = 0.0081). At long-term after the operation, clinical findings, including the platelet count, were not different between the two groups. Computed tomography revealed a pseudocyst in 9 (53%) of 17 patients examined in the DPS group and in 3 (75%) of 4 patients examined in the SPDP group at short-term after operation. All patients with pseudocysts were asymptomatic. Two asymptomatic patients (one in the DPS group and one in the SPDP group) first developed a pseudocyst at long-term after the operation. The alteration of glucose tolerance was similar between the two groups. Postoperative pancreatic exocrine function (the N-benzol-L-tyrosyl-p-aminobenzoic acid test) was not different between the two groups. These data suggest that SPDP with preservation of the splenic vessels can be satisfactorily performed without elongating operative time and postoperative hospital stay or increasing risk of postoperative complications, with the exception of increased platelet count in the DPS group at short-term after the operation. Thus, SPDP is worth considering as one of the options for the treatment of benign lesions of the body or tail of the pancreas.

Adult↗

PubMedDate not supplied

[Duodenum preserving cephalic pancreatectomy and pancreatico-gastrostomy in the surgical treatment of the chronic pancreatitis].

UNLABELLED: Cephalic pancreaticoduodenectomy had been introduced in surgery practice by O. Whipple, for the treatment for the cancer of ampulla of Vater, later this indication has also been extended to other pancreatic disorders including the cases of chronic pancreatitis. Cephalic pancreatectomy with the remaining of the duodenum used lately in the treatment of chronic pancreatic eliminates the disadvantages of the operation Whipple. Further on, we present a case of chronic pancreatitis where a cephalo-pancreatic resection has been done with the remaining of the duodenum, the pancreatic blunt being anastomosed with the stomach by pancreatico-gastrostomy, terminal-lateral, a cystoduodenostomy had being done to this patient. Ten months after the surgery, the patient is in a good general state, without subjective pain, putting weight, and a glucose metabolism without changes. CONCLUSIONS: Pancreatico-gastrostomy may represent a modality of solving the pancreatic blunt after the cephalic pancreatectomy with the remaining of the duodenum.

Aged↗

PubMedDate not supplied

Retroperitoneoscopic laparoscopic distal pancreatectomy with spleen salvage.

BACKGROUND/AIMS: Laparoscopic pancreatic surgery has now developed as a clinical practice. In urological surgery, direct extraperitoneal surgery has become popular in laparoscopic adrenalectomy and nephrectomy. As the pancreas is also an organ located in the retroperitoneal cavity, we evaluate the efficacy of retroperitoneoscopic laparoscopic distal pancreatectomy. METHODOLOGY: Specific-pathogen-free Large Yorkshire pigs were studied. No major bleeding episodes were encountered. After carbon dioxide insufflation, the abdominal viscera were inspected with a laparoscope. Below the left costal convexity, the balloon dissector was introduced and the second port was inserted in the retroperitoneal cavity. The scope was inserted using that port and additional two ports were inserted into the retroperitoneal cavity. RESULTS: The tail to body of the pancreas were easily mobilized from the retroperitoneum. The identified splenic artery and vein were carefully isolated from the pancreas. After lap-disk was applied to a 4-cm incision, the tail of the pancreas was pulled out to resect using various devices. The cut surface of the pancreas resected with ultrasonic dissector showed a less damaged area than that with monopolar electrocautery and bipolar electrocautery. CONCLUSIONS: Retroperitoneoscopic laparoscopic distal pancreatectomy is a rational procedure and is safe. As the pancreatic parenchyma has greater water content, the devices of ultrasonic dissector seem to be helpful.

Animals↗

PubMedDate not supplied

Laparoscopic distal pancreatectomy for lymphoepithelial cyst of the pancreas.

Lymphoepithelial cysts are rare pancreatic lesions. This case report describes the first excision of such a lesion by laparoscopic distal pancreatectomy which is a recognized procedure for treatment of cystic pancreatic neoplasms. Our patient underwent complete excision of the lesion and has enjoyed complete resolution of his symptoms. Laparoscopic distal pancreatectomy may be a suitable choice for first-line therapy for such lesions.

Humans↗

PubMedDate not supplied

Laparoscopic distal pancreatectomy for insulinoma with preservation of the spleen.

We report on a successful laparoscopic distal pancreatectomy due to insulinoma, preserving the spleen and the splenic vessels in a 29-year-old male patient who presented with repeated syncope due to hypoglycemia. The ultrasound exam did not show the pancreatic lesion; it was only the angiotomography of the pancreas that revealed a 3-cm mass located at the transition from the body to the tail of the pancreas. The laparoscopic distal pancreatectomy was performed using a harmonic scalpel (Ethicon EndoSurgery/UltraCision), without mechanical suturing. There were no intra- or postoperative complications or hypoglycemias during the 6 months of follow-up. When it is performed by experienced laparoscopic surgeons, this is a technically feasible procedure, safe for the treatment of benign lesions of the pancreas body and tail.

Adult↗

PubMedDate not supplied

Modified extended distal pancreatectomy for carcinoma of body and tail of pancreas.

The prognosis of carcinoma in the body and tail of the pancreas is disappointing due to the low rate of resectability, since it is usually presented at an advanced stage with local invasion of adjacent major vessels. However, the postoperative survival, if resectable, is similar to carcinoma of the pancreatic head. Aggressive approach, by applying extended distal pancreatectomy with the resection of the celiac axis, may increase the resectability but promote the potential risk of hepatic dysfunction and biliary necrosis after the sudden interruption of the common hepatic artery. We modified the procedure by reanastomosis between the stump of the celiac axis and common hepatic artery without vascular graft to manage a 50-year-old woman with locally advanced carcinoma of the body and tail of pancreas. She had 2 years of disease-free survival. This modified extended pancreatectomy may be a feasible and safer procedure.

Anastomosis, Surgical↗

PubMed2005

[A study of recurrent pancreatic cancer with metastatic liver tumors after pancreatectomy].

BACKGROUND: Pancreatectomy is the best treatment for pancreatic cancer. However, there is a high risk of post-operative complications, such as local recurrence, metastatic lymphadenopathy, carcinomatosa peritonitis and liver metastasis. Presently, there is no significant treatment that has yet had a strong impact on recurrent pancreatic cancer. This study was conducted concerning recurrent pancreatic cancer with metastatic liver tumors after pancreatectomy. SUBJECTS AND METHODS: Between April 1998 and March 2005, our institute treated recurrent pancreatic cancer patients with liver metastasis. This study consisted of groups who received therapy and those who did not, and their subsequent survival rate was also studied. RESULTS: Nine cases had a recurrent pancreatic cancer with metastatic liver tumors. According to the treatment modality, the study population was classified into two groups: one group consisted of 4 patients with no treatment and the other group consisted of 5 patients who received treatment with gemcitabine (GEM). The mean survival rate for the group who received no treatment was 6.6 months. The mean survival rate for the group who received the treatment was 22.3 months. In addition, one year survival rate for those who received no treatment was 0%. The one year survival rate for those who received the treatment was 75%. The group with treatment showed better results in overall mean survival rates, as well as a higher one-year survival rate than the group with no treatment. The GEM administration included both intraarterial infusion and intravenous infusion. CONCLUSIONS: Prolongation of the survival period was obtained by administration of GEM for recurrent pancreatic cancer with metastatic liver tumors and inoperable advanced pancreatic cancer. We attempted to utilize the active treatment for recurrent pancreatic cancer with metastatic liver tumors. Thus, it was indicated that the therapy can be effective against recurrent pancreatic cancer with metastatic liver tumors.

Aged↗

PubMedDate not supplied

[Preliminary data on post-pancreatectomy diabetes mellitus treated by islet-cell autotransplantation].

The present study describes the first islet autotransplant program in Romania, and the first 3 cases of subtotal pancreatectomy for chronic pancreatitis combined with islet autotransplant. The primary objective was to pain relief by pancreatic resection, but also to preserve the endocrine function by islet autotransplant. Extensive distal pancreatectomy is effective in relieving pain, but should be limited to patients with small duct disease, in whom more conservative methods have failed, because of severe metabolic consequences. Islets were prepared by Liberase digestion of the excised pancreas, and infused unpurified into the portal vein in one case and in the omental pouch and peritoneum in two cases. All patients were relieved of pain, have achieved insulin independence, and positive C peptide levels, but one patient died of a acute bronchopneumonia 60 days post-transplantation. The mean islet yields were 2100 islet equivalents/Kg body weight. Islet autotransplantation can be considered a useful therapeutic option serving to prevent the occurrence of surgically-induced diabetes. The results have indicate that the omental pouch is a viable site for islet autotransplantation, that can accommodate a large tissue volume, is easy to access to implant, and the IBMIR (instant blood mediated inflammatory reaction) may be less severe.

Adult↗

PubMed2006

[Spleen-preserving distal pancreatectomy in treatment of solid-pseudopapillary neoplasm].

OBJECTIVE: To investigate the feasibility and safety of spleen-preserving distal pancreatectomy with conservation of the splenic arteries and veins in treatment of benign neoplasms of distal pancreas. METHODS: Four patients with solid-pseudopapillary neoplasm, 1 males and 3 females, aged 30 (17 - 37), underwent laparotomy. The distal pancreas with tumor was cut. The perforating branches between the splenic artery and vein and the distal pancreas were isolated, ligated, and cut. The splenic artery and vein and the short and left gastric vessels were all preserved. The spleen remained intact. RESULTS: The mean operation time was 208 minutes +/- 52 minutes, and the mean blood loss was 475 ml +/- 96 ml. Blood transfusion was not necessary. The mean post-operative hospital stay was 18 days +/- 13 days. No post-operative complications were found except for pancreatic leakage occurring in one patient that was cured by conservative treatment. No metastasis and recurrence was found. CONCLUSION: Safe and feasible, spleen-preserving distal pancreatectomy with conservation of the splenic arteries and veins is one of the best choices for treatment of benign and borderline tumors of pancreas.

Adolescent↗

PubMed1991

[Resection of the portal vein in pancreatectomy for cancer: technical considerations. Apropos of 4 cases].

Out of 150 carcinomas of the pancreas operated from 1970 through 1989, 50 pancreatectomies were performed, including 4 cases of segmental resection of portal vein with total pancreatectomy (2 cases) or duodenopancreatectomy (2 cases). The technical procedure is described and discussed. Segmental resection of portal vein is rare in our experience and has been always performed out of necessity because of the over estimation of the resectability. However, mortality and post-operative stay are not increased.

Adenocarcinoma↗