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At least 433 records · Page 24Linked to original sources

PubMedDate not supplied

Splenic preserving distal pancreatectomy of a solid pseudopapillary pancreatic tumour.

BACKGROUND: Solid pseudopapillary tumours are rare primary lesions of the pancreas. They occur most commonly in young female patients. They are traditionally regarded as benign tumours with malignant potential. AIM: We describe the incidental finding of this rare pancreatic lesion in a healthy 37-year-old female which was treated with splenic preserving distal pancreatectomy. RESULTS: The patient underwent curative resection with an uncomplicated postoperative course. Histology revealed the tumour origin with clear resection margins. The patient did not require adjunct therapy. Follow-up computed tomography (CT) scanning has demonstrated no evidence of local recurrence. CONCLUSION: The authors conclude that splenic preservation is safe and desirable where no compromise in oncological principles exists. Despite improvements in histological characteristics of solid pseudopapillary tumours, no prognostic features exist and each case must be followed-up on an individual basis.

Adult↗

PubMed2005

Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia.

AIMS/HYPOTHESIS: Postprandial hypoglycaemia following gastric bypass for obesity is considered a late manifestation of the dumping syndrome and can usually be managed with dietary modification. We investigated three patients with severe postprandial hypoglycaemia and hyperinsulinaemia unresponsive to diet, octreotide and diazoxide with the aim of elucidating the pathological mechanisms involved. METHODS: Glucose, insulin, and C-peptide were measured in the fasting and postprandial state, and insulin secretion was assessed following selective intra-arterial calcium injection. Pancreas histopathology was assessed in all three patients. RESULTS: All three patients had evidence of severe postprandial hyperinsulinaemia and hypoglycaemia. In one patient, reversal of gastric bypass was ineffective in reversing hypoglycaemia. All three patients ultimately required partial pancreatectomy for control of neuroglycopenia; pancreas pathology of all patients revealed diffuse islet hyperplasia and expansion of beta cell mass. CONCLUSIONS/INTERPRETATION: These findings suggest that gastric bypass-induced weight loss may unmask an underlying beta cell defect or contribute to pathological islet hyperplasia, perhaps via glucagon-like peptide 1-mediated pathways.

Adult↗

PubMedDate not supplied

Jejunal loop obstruction at the ligament of Treitz: a distinct radiological and clinical picture of recurrence after subtotal pancreatectomy.

Of 99 patients operated on with subtotal pancreatectomy due to ampullary carcinoma, five had a local recurrence in the pancreatic bed at the ligament of Treitz. The patients all had distinct symptoms: recurrent bouts of fever, general malaise, and rapid loss of weight. They had little pain, but all were jaundiced in spite of absence of marked compression of the bile ducts. Computed tomography or ultrasound could not detect the small, local recurrence that was obstructing the jejunal loop 10-15 cm distal to the hepaticojejunostomy, but as an indirect sign of the recurrence, the distended small bowel loop proximal to the ligament of Treitz was clearly seen in all patients.

Aged↗

PubMed2003

Subtotal pancreatectomy for chronic pancreatitis.

Chronic pancreatitis results when pancreatic structure or function is irreversibly damaged by repeated or ongoing inflammation, regardless of the underlying etiology. Most patients present with medically intractable pain and radiological evidence of diffuse gland involvement. Surgical therapy is directed mainly toward palliation of symptoms, and cure is unusual except when the inflammatory process is limited to a specific segment of the pancreas. Surgical strategy should be individualized on the basis of alterations in pancreatic morphology and duct anatomy. In properly selected patients, duct drainage procedures effectively relieve pain and preserve pancreatic function with low perioperative morbidity and mortality. Extensive distal pancreatectomy is effective in relieving pain, but it can be technically challenging and in general should be limited to patients with small-duct disease because of severe metabolic consequences. Intraportal islet cell autotransplantation or segmental pancreatic autotransplantation may ameliorate the long-term effects of insulin-dependent diabetes, but it will have limited applicability until methods for optimizing and purifying islets are developed and the optimal route and site of islet cell implantation have been identified.

Chronic Disease↗

PubMed1998

Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy.

Pancreatic fistula is a major form of morbidity following pancreatic resection. We conducted a nonrandomized clinical trial comparing the sealing and sandwich techniques of spraying fibrin glue to prevent pancreatic fistula following distal pancreatectomy. The pancreas was transected with a scalpel to identify and suture the main pancreatic duct and its small branches. In the sealing group, fibrin glue was sprayed over the closed pancreatic stump and sutures. Alternatively, in the sandwich group fibrin glue was sprayed so as to cover and join the cut surface of the pancreatic remnant, which was then held closed with sutures. Altogether 111 patients were included in the study (90 with gastric cancer, 10 with esophageal cancer, and 11 with pancreatic cancer). Patients were nonrandomly assigned to the sandwich or the sealing group. Morbidity was 21.8% for the patients in the sandwich group versus 33.9% in the sealing group. Pancreatic fistulas occurred in 9.0% of the sandwich group versus 26.8% of the sealing group. The incidence of fistula was thus significantly lower in the sandwich group. The incidence of fistula was also significantly lower in the sandwich group for gastric malignancy patients undergoing extended radical lymphadenectomy down to the paraaortic lymph nodes combined with left adrenalectomy. Of the patients with gastric malignancy, pancreatic fistulas occurred in 9.3% of the sandwich group versus 25.5% of the sealing group. The fibrin glue sandwich technique is simple and reliable and should be valuable for complementing other prophylactic methods of preventing pancreatic fistula.

Adult↗

PubMed2001

Impaired beta-cell regeneration after partial pancreatectomy in the adult Goto-Kakizaki rat, a spontaneous model of type II diabetes.

In the Goto-Kakizaki (GK) rat, a genetic model of type II diabetes, there is a restriction of the beta-cell mass as early as fetal age, which is maintained reduced in the adult animal. In order to investigate the beta-cell growth potential in the adult hyperglycemic GK rat, and to determine whether it differs from non-diabetic Wistar (W) rats, we have performed 90% pancreatectomy (Px) in 8- to 10-week-old male animals. Spontaneous beta-cell regeneration and involvement of beta-cell replication, beta-cell neodifferentiation from ductal precursor, and beta-cell apoptosis were evaluated by immunocytochemistry and morphometry at different time points: day 0 (D0), D2, D7, and D14 after Px. In GK rats, deterioration of the diabetic state with severe and chronic hyperglycemia was evident as soon as D2, while in W/Px, normoglycemia to moderate hyperglycemia was observed. In W/Px rats, the total beta-cell mass gradually increased on D2, D7, and D14, as compared to non-Px W rats. By contrast, in GK/Px rats, there was only a non-significant tendency to increased total beta-cell mass, as compared to related non-Px group. Adult GK rats displayed lower beta-cell proliferation rates compared to W. In response to Px, early increase of beta-cell proliferation was present in both W/Px and GK/Px rats on D2, but it returned to non-Px values in GK rats on D7 and D14, while in W/Px rats beta-cell proliferation was maintained increased as compared to non-Px W rats. The very low apoptotic beta-cell frequency on D0, D2, D7, and D14, in both W and GK, either non-Px or Px, did not allow us to conclude that any significant differences exist between the different groups. beta-cell neoformation from ducts, and more specifically from foci of regeneration, was found to be less activated in GK/Px rats as compared to W/Px. Together, these results suggest that in the adult hyperglycemic GK rat undergoing Px, beta-cells still have the capacity to regenerate, but with a lower efficiency as compared to non-diabetic W rats. This defect in the GK rat is the result of both genetic predisposition contributing to an altered beta-cell neogenesis potential already present in the neonatal period, and environmental factors (chronic hyperglycemia) leading to a reduced beta-cell proliferative capacity specific to the adult animals.

Age Factors↗

PubMed2005

Indications and technique of central pancreatectomy-early and late results.

BACKGROUND AND AIM: Central pancreatectomy (CP) is an operation that allows one to resect benign or low grade malignant tumours located in the pancreatic isthmus that are not suitable for enucleation. The main advantage of this operation compared with major resections is that it permits to spare normal pancreatic parenchyma. PATIENTS AND METHODS: The operation is carried out by exposition of the pancreatic neck involved by the lesion. Thereafter, the gland is dissected from the splenic artery and porto-mesenteric axis and divided with a 1 cm clear margin. The cephalic stump is sutured, and the distal stump is anastomosed end-to-end or end-to-side with a Roux-en-Y jejunal loop. We treated 20 patients with this technique. The indications for CP were: serous cystadenoma in seven patients, mucinous in three, solid cystic papillary tumour in one, metastasis from renal cancer in one and endocrine tumour in eight patients. RESULTS: Mortality rate was 0% and morbidity rate was 35%; pancreatic fistulas occurred in 25% of the cases and were treated conservatively. Results of postoperative endocrine and exocrine function tests were normal in all controlled patients. All the patients are alive without evidence of local recurrence. CONCLUSION: CP is a safe technique for benign or low-grade malignant tumours of the pancreatic neck that allows one to cure the tumour with evident functional results without increasing the risk to the patient.

Anastomosis, Surgical↗

PubMed2004

Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas.

An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.

Aged↗

PubMed2001

Laparoscopic distal pancreatectomy for blunt injury to the pancreas. A case report.

Laparoscopic pancreatic resection has not been reported for traumatic injuries to the pancreas. We present the case of a laparoscopic distal pancreatectomy performed on a 10-year-old boy after he sustained a distal transection of the pancreas due to blunt abdominal trauma. The spleen and its vessels were preserved. The patient was sent home on postoperative day 3 without any postoperative complications. Performing an advanced laparoscopic pancreatic procedure is feasible, in the trauma setting, particularly in children.

Athletic Injuries↗

PubMed2005

An improved method of 90% pancreatectomy using a low dose of streptozotocin at the pancreaticoduodenal artery results in a rapid diabetic stage in dogs.

An improved method of inducing diabetes in dogs was developed. This method included 90% pancreatectomy, 2 mg/kg streptozotocin (STZ) perfused into pancreaticoduodenal artery, and the fixation suture of the duodenum to the costo-abdominal wall. Vasopressin injection administered to the animals before surgery reduced bleeding. All dogs used in this procedure survived and became diabetic. One month after the procedure the pancreatic islets were reduced in volume and the number compared with pancreas tissue obtained during the surgery. Acinar tissue remained with a normal histology, and exocrine function maintained the physiological parameters, except for a soft faecal consistency. We conclude that this procedure is effective in inducing experimental diabetes in dogs.

Animals↗

PubMed2002

Hand-assisted laparoscopic distal pancreatectomy in pigs using our original hand device (Lap Disc).

We analyzed the safety and feasibility of a hand-assisted laparoscopic distal pancreatectomy (HALDP) in pigs. We performed HALDP in five cases using our original hand device (Lap Disc). The procedures in all cases were successfully performed. The Lap Disc was very useful for performing HALDP because of its compact design and simple usage. This preliminary experience suggests that this device could be used to perform HALDP as well as other procedures in humans.

Animals↗

PubMed1977

Total pancreatectomy for carcinoma of the pancreas.

Survival after partial pancreaticoduodenectomy (Whipple procedure) for carcinoma of the pancreas is uniformly poor. In the absence of nodal metastasis this may be due to extension of tumor beyond the line of resection of the pancreas or to a multicentric origin of the tumor. The material reviewed contained an illustration of the latter circumstance and provides a logical reason for recommending total pancreatectomy as the procedure of choice in resectable pancreatic carcinoma.

Cystadenocarcinoma↗

PubMed1980

Experience with total pancreatectomy.

Total pancreatectomy for benign disease should be considered only in highly selected patients and then only after lesser surgical procedures have failed. At present, truncal vagotomy and adequate gastrectomy should be part of the operation to prevent marginal ulceration. A multitude of undesirable problems, many requiring reoperation, may arise postoperatively and can compromise an otherwise excellent outcome with regard to pain control.

Adult↗

PubMed1981

Total pancreatectomy for ductal adenocarcinoma of the pancreas. Mayo Clinic experience.

This review reveals that, once again, surgical therapy of ductal adenocarcinoma of the pancreas has been thwarted, probably by the inherent biologic aggressiveness of this particular malignancy. The operative mortality rate (greater than 10 percent) coupled with the 5 year survival rate of 2.3 percent is eloquent testimony to this. Multicentric disease occurred in one third of the patients, whereas extrapancreatic spread was found in half of the resected specimens. At 1 year, the only statistically favorable determinants were multicentricity and female sex. The main bonus of total pancreatectomy appears to be the elimination of pancreatojejunal anastomosis with its lethal complications.

Carcinoma, Intraductal, Noninfiltrating↗

PubMed1985

Technique of regional subtotal and total pancreatectomy.

The technique of regional pancreatectomy as detailed is divided into five phases. The procedure includes en bloc regional lymph node dissection, peripancreatic soft tissue resection, and resection with reconstruction of the pancreatic segment of portal vein. The pancreatic resection can be subtotal or total.

Hepatic Artery↗

PubMed1994

Pancreatic pleural effusion: an indication for emergency distal pancreatectomy and Roux-en-Y pancreatico-jejunostomy.

A previously healthy 2-year-old boy was admitted because of shortness of breath, cough, and fever; there was minimal abdominal pain. He had recurrent right, followed by left pleural effusions, which contained markedly elevated amylase levels and high protein content. The pleural fluid amylase levels were disproportionately higher than the serum amylase levels. His abdominal signs were minimal. Surgical exploration showed a disruption of the proximal pancreatic duct. Distal pancreatectomy and Roux-en-Y pancreatico-jejunostomy were performed. After a complicated postoperative course he was discharged well and has remained so for more than 2 years.

Anastomosis, Roux-en-Y↗

PubMed1992

Pancreatic function following partial pancreatectomy and anastomosis of the pancreatic duct to the stomach or duodenum in dogs.

The effects of pancreatic duct anastomosis to stomach (stomach group) or duodenum (duodenal group) on pancreatic function were examined in dogs following two thirds pancreatectomy. Normal fasting blood glucose concentrations were maintained in both groups despite significant reductions in glucose tolerance in the stomach group, and reductions in fasting insulin and insulin peak response in both groups. Pancreatic exocrine function was significantly decreased in both groups, though plasma p-aminobenzoic acid (PABA) concentrations were generally higher in the duodenal group. A correlation was found between plasma trypsin-like immunoreactivity (TLI) and pancreatic weight. These results indicate that anastomosis of the pancreas to bowel can be undertaken with minimal postoperative complications and that the site of the anastomosis influences pancreatic function. They suggest that preservation of more than one third of the pancreas is required for optimal function. The complementary information provided by the PABA and TLI tests suggests their dual application will be clinically useful for the detection and characterisation of naturally occurring pancreatic diseases.

4-Aminobenzoic Acid↗

PubMed1995

Lack of effect of CS-045, a new antidiabetic agent, on insulin secretion in the remnant pancreas after 90% pancreatectomy in rats.

We assessed the effect of CS-045, a new hypoglycemic agent, on B-cell function in partially pancreatectomized rats. At the age of 4 weeks, male Wistar rats were subjected to 90% pancreatectomy (Px). For 2 weeks starting at 6 weeks after surgery the Px rats were treated with CS-045 (CS rats) mixed with chow pellets in a proportion of 0.2% (w/w). To compare the efficacy of CS-045 with that of insulin therapy, an osmotic pump was implanted to release insulin (1.2 units/day) into the intraperitoneal cavity of the Px rats (Is rats). Plasma glucose levels in the CS and Is rats were significantly lower than in the control Px rats; however, no marked improvement in plasma glucose or insulin levels was observed in glucose tolerance test (2 g/kg, i.p.) in the CS rats. Insulin secretion by the isolated perfused pancreas in response to 16.7 mM glucose showed a biphasic pattern, but was slightly reduced in the Px and CS rats compared with the Is rats. Insulin secretion induced by 19 mM arginine was unaffected by the treatment. The insulin content of the CS rats was significantly greater than in the Px and Is rats. Histological observations suggested regranulation of the pancreatic islets of the CS rats. B-cell areas within the islet were restored to normal levels in the Cs and Is rats. These findings indicate that the hypoglycemic effect of CS-045, which is not mediated by insulin secretion from the residual pancreas, prevents destruction of the islet.

Animals↗