Distal pancreatectomy with preservation of the spleen and splenic vessels.
This article draws attention to the concept of distal pancreatectomy with splenic preservation including the splenic artery and vein.
Chronic Disease↗
SEARCH · PubMed Health
Results for “PANCREATECTOMY”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Partial elective pancreatectomy is curative in focal form of permanent hyperinsulinemic hypoglycaemia in infancy: A report of 45 cases from 1983 to 2000.
BACKGROUND/PURPOSE: Permanent hyperinsulinemic hypoglycaemia in infancy (PHHI)I is a severe disease that leads to brain damage. Since 1989, pathologists have identified 2 different forms of the disease: a diffuse form (DiPHHI) and a focal form (FoPHHI). The purpose of this study was to adapt surgical techniques in case of FoPHHI to cure these infants without risk of diabetes. METHODS: All patients with PHHI underwent pancreatic venous sampling (PVS) and elective partial pancreatectomy (EPP). Molecular biology and immunohistochemistry were used to ascertain that FoPHHI was a different disease from DiPHHI. RESULTS: 45 EPPs were performed, guided by PVS and peroperative pathology. The lesions were 17 in the head, 4 in the isthmus, 6 in the body, 15 in the tail of the pancreas. Age at surgery ranged from 25 days to 4 years. Two patients already had been operated on elsewhere, and the focal lesion could be found at second operation. All 45 patients except one, were cured with euglycemia at both fasting and hyperglycaemic tests. Molecular biology has shown a specific anomaly in FoPHHI, which never has been encountered in DiPHHI. CONCLUSIONS: PHHI is not a homogeneous disease. In one third of cases, only a small amount of endocrine pancreas is abnormal, and conservative surgery is mandatory. The pre- and perioperative conditions to point out the focal pancreatic lesion are described.
Child, Preschool↗
Pancreatic hormones and plasma glucose: regulation mechanisms in the goose under physiological conditions. I. Pancreatectomy and replacement therapy.
Measurements of plasma GLI and IRI in normal fasting geese, before and during constant I.V. infusion of saline, gave GLI/I ratios of 1.32 +/- .07 and 1.34 +/- .03 (w/w). As total pancreatectomy markedly reduces the pancreatic hormone level, leading to a mortal hypoglycaemia, we attempted to maintain plasma glucose within the normal range by constant I.V. infusion of glucagon and insulin into operated animals. The results as follows: 1. Blood glucose levels can be maintained within the normal range during experiments lasting 6 or more hours with a constant G/I ratio. 2. The G/I ratio obtained in operated animals (.96 +/- .12) is near to, but significantly lower (p less than .005) than, the GLI/I ratio measured in normal animals. This difference may be explained by the presence of a small amount of circulating gut GLI in the 2nd group.
Animals↗
[Anesthesiological management of pancreatectomy with curative intention in pancreatic carcinoma].
Pancreatectomy for pancreatic carcinoma makes high demands on the perioperative anesthesiologic management of these patients. This survey is centered on pathophysiological reflections related to the choice of the anesthesia and accompanying therapy, concerning the pathological mechanisms of intra- and postoperative complications. The influences of the surgical as well as the anesthesiological procedure on the autonomous nervous system and splanchnic blood flow, the organo-specific consequences of the resection and the possible influences on the immune system are discussed. Recommendations for perioperative medical care of these patients are derived from it. Central points are an anesthesiologic management adapted to the patient with regard to pathophysiological changes caused by surgery, monitoring and therapy of the disturbed fluid balance, postoperative intensive care as well as an optimal pain treatment.
Anesthesia↗
Pancreatic hormones disappearance after total pancreatectomy in the duck: correlation between plasma glucagon and glucose.
The decline of 3 plasma pancreatic hormones, glucagon (G), insulin (I) and somatostatin (S) was studied in fasting ducks after total pancreatectomy. The results show that the decrease of plasma glucose is highly correlated with the disappearance of G, while no important variation of the G/I ratio occurs during the period of observations (80 minutes) the animal being kept fasted. No participation of pancreatic S in glucose metabolism could be detected, the origin of peripheral S in the fasting state seeming due to the intestine for about 50%.
Animals↗
Retroperitoneoscopic radical nephrectomy with concomitant distal pancreatectomy: case report.
Whereas laparoscopic radical nephrectomy has emerged as the standard of care for most low-stage renal tumors, laparoscopic pancreatic surgery remains uncommon. We describe a retroperitoneoscopic radical nephrectomy and concomitant distal pancreatectomy for a large left renal mass with suspected involvement of the adrenal gland and the distal pancreas.
Adrenal Glands↗
Distal pancreatectomy and islet autotransplantation for chronic pancreatitis.
Eight patients with chronic pancreatitis underwent 95% pancreatectomy and islet autotransplantation. The partially purified islet material was transplanted into the liver at the time of surgery via embolization into the portal vein. Hyperglycemia requiring insulin therapy developed in all patients immediately followed surgery. Six patients subsequently became normoglycemic an average of 28 days following the transplant (range: 8-90 days). Three of these patient have remained normoglycemic on a regular diet nine, 18, and 22 months following transplant. The other three redeveloped hyperglycemia and insulin dependency three, six, and eight months after surgery. Indirect measurement of functioning islet cell mass by intravenous glucose tolerance testing preoperatively was predictive of the outcome of the transplant. All patients developed portal hypertension (14-60 cm H2O) during tissue injection into the portal vein. Portal hypertension persisted in one patient and required treatment with a mesocaval shunt. The patient subsequently died of hepatic necrosis. Postoperative catheterization in four patients, three to 12 months posttransplant, revealed that portal pressure had returned to normal. Clinically, all seven surviving patients were improved following surgery.
Adult↗
Factors influencing survival after total pancreatectomy in patients with pancreatic cancer.
A retrospective analysis of factors influencing short-term and long-term survival after total pancreatectomy for pancreatic cancer was done in 86 patients. Among the 41 factors studied, hospital mortality was significantly affected by age over 70 years, preoperative diabetes, pain as presenting symptom, S-bilirubin, preoperative bile drainage, prophylactic antibiotic treatment, stage of the tumor, and experience of the surgeon. The only factors which had a statistically significant influence on long-term survival were stage of the tumor and sex of the patient. It is concluded that improvement of long-term survival can mainly be achieved by earlier identification and removal of the tumors and by introduction of more efficient adjuvant therapy. Whereas these goals probably will require a long time to be reached, the majority of factors associated with worsening of hospital mortality may be avoided by a strict selection of the patient, the tumor and the surgeon.
Adenocarcinoma↗
Experience with 95% pancreatectomy and splenic salvage for neonatal nesidioblastosis.
Conventional 85% pancreatectomy with splenectomy performed for management of hypoglycemia of neonatal nesidioblastosis has been followed by a dismal prognosis characterized by post-splenectomy sepsis, recurrent hypoglycemia, permanent brain damage, and a high mortality. For our last eight infants we have found it possible to remove at least 95% of the pancreas, preserving the blood supply to the spleen as well as the duodenum. This has permitted satisfactory control of the hypoglycemia and long-term septic complications have been avoided. Follow-up evaluation up to 20 years with successful control of hypoglycemia without progressive brain damage indicates the value of this primary extensive surgical approach.
Adenoma, Islet Cell↗
The complications of pancreatectomy.
This paper analyses the early postoperative complications after 285 pancreaticoduodenectomies performed during the past 15 years in the Surgical University Clinic, Mannheim. There were 235 partial (Whipple) and 52 total pancreatectomies performed for pancreatic and periampullary tumors (181 patients) and complicated chronic pancreatitis (104 patients). A total of 92 complications requiring relaparotomy in 42 patients ended fatally in nine patients. The overall operative and hospital mortality rate was 3.1%. The most frequent and most dangerous were complications at or around the pancreaticojejunal anastomosis, which occurred 25 times with five deaths. Postoperative hemorrhage was seen in 16 patients; endoscopic treatment in four patients and operation in 12 patients was successful in stopping the bleeding in all but one patient. Eight biliary fistulae either ceased spontaneously (3 patients) or after operative reintervention (5 patients) without any mortality. Control of these complications depends on four lines of approach: (1) before operation: optimal preparation of the jaundiced patient including endoscopic transpapillary decompression of the common duct; (2) during operation: a meticulous and standardized technique is mandatory; (3) after operation: continuous observation in the surgical intensive care unit is essential for the timely detection of possible complications; and (4) early reintervention can salvage the great majority of these patients with deleterious complications.
Adenocarcinoma↗
Total pancreatectomy for ductal cell carcinoma of the pancreas. An update.
Forty-eight patients with ductal cell carcinoma of the pancreas underwent total pancreatectomy. During 1970-1976, there were four deaths (a mortality of 18%). During the last twenty-eight operations (1977-1986), there were no hospital deaths. Seventeen per cent of the patients suffered intraoperative complications involving the mesenteric vessels. Twenty-seven per cent suffered postoperative complications. Twenty-five per cent of the patients left the hospital within 2 weeks, 50% left within 4 weeks, and another 25% remained in the hospital for longer than 4 weeks. Thirty-five per cent of the patients have returned to their preoperative job or similar life activity. Another 35% were able to lead an active life but did not return to regular work, and 30% were to some degree incapacitated by their operative procedure and disease. Twenty-one per cent of the patients lived for 4 years, and 14% survived for 5 years.
Adult↗
Total pancreatectomy with preservation of the duodenum and pylorus for chronic pancreatitis.
In an effort to minimize the nutritional complications that follow resection of the pancreas for severe chronic pancreatitis, the authors have performed a duodenum-preserving total pancreatectomy in eight patients for severe unremitting pain requiring large doses of opiate analgesia. Good relief of pain was obtained in six patients (75%), in whom the quality of life was undoubtedly improved. There were no problems with the control of diabetes after this procedure in any of these patients, and no patient has suffered any hypoglycemic attacks requiring medical treatment. This improved control of the diabetic state is probably related to a more physiologic state of the upper digestive tract, enabling a normal food intake. The authors found the operation to be technically difficult, however, and although there were no post-operative deaths, major complications were encountered in four patients. These consisted of postoperative bleeding requiring reoperation (two patients), sepsis, and a duodenal fistula, which progressed to stenosis.
Adult↗
Islet transplantation using an immunoprotective membrane in dogs that have undergone a pancreatectomy.
The use of a selectively permeable membrane to transplant nonsyngeneic tissue without accompanying immunosuppressive therapy has been investigated using two approaches. The first hybrid artificial pancreas is implanted as a vascular shunt in which blood circulates through the lumen of a tubular membrane. The islet tissue is distributed within a chamber surrounding the membrane enclosed by an acrylic housing. Studies with diabetic dogs that have had pancreatectomies have demonstrated that these devices could replace exogenous insulin therapy for at least 6 months in five animals. This report presents data on two of these dogs, demonstrating viability and function of the transplanted tissue after 1 year. As an alternative to the vascular device, islets sealed within cylindrical permselective membrane chambers have been implanted in the peritoneum. Preliminary data from three dogs indicate that the nonvascular implants can also regulate fasting glucose levels in the diabetic dog model.
Animals↗
Proximal pancreatectomy in the surgical management of chronic pancreatitis.
During the past three decades, important advances in our understanding of the pathophysiology of chronic pancreatitis (CP), improved results of major pancreatic resections (including pancreatoduodenectomy), and integration of sophisticated diagnostic methods in clinical practice resulted in significant changes in our surgical approach to CP. Proximal pancreatectomy (including the pancreatoduodenectomy and the newer duodenum-preserving and common bile duct-preserving Beger and Frey procedures) achieved good results concerning pain relief (>80%) and quality of life in selected patients with head-dominant CP. Beger and Frey procedures were associated with lower early and late mortality and morbidity. However, when there is strong suspicion of an underlying malignancy, a pancreatoduodenectomy should be considered in surgically fit patients, as this is an adequate procedure for both CP and pancreatic cancer.
Chronic Disease↗
A case of total esophago-gastro-duodeno-jejunectomy and partial pancreatectomy for lye burns, and reconstruction with colon interposition.
We report a unique case of extensive surgery for severe lye burns. It included total esophago-gastro-duodeno-jejunectomy and partial pancreatectomy. We were unable to find a similar successfully treated case in English-language literature. Ninety-one days after the initial emergency surgery, the patient successfully underwent reconstruction of alimentary tract with isoperistaltic left colon interposition between proximal cervical esophagus and ileum.
Burns, Chemical↗
Heterotopic autotransplantation of the distal pancreas segment after total pancreatectomy for cancer of the head of the pancreas.
Autotransplantation of the distal pancreas segment with pancreaticojejunostomy was performed in four patients with cancer of the head of the pancreas to preserve endocrine pancreatic function after extended total pancreatectomy. All patients had tumor involvement of both the celiac axis and the portal vein. The pancreatic graft was determined to be cancer-free by frozen section histologic and pancreatic juice cytologic examinations. The distal pancreas segment was autotransplanted to the iliac vessels heterotopically and placed in the extraperitoneal pocket to avoid untoward effects of any local recurrence or pancreatic leakage. This procedure, in the form of reconstruction, might be called modified subtotal pancreatoduodenectomy. Postoperatively, all patients remained normoglycemic without exogenous insulin administration, and their quality of life was considered satisfactory.
Aged↗
Effect of aging on B-cell function and replication in rat pancreas after 90% pancreatectomy.
We studied the effect of aging on B-cell function and replication in depancreatized rats. Male Wistar rats, at the ages of 1, 5, and 15 months, underwent 90% pancreatectomy (Px) or a sham operation, and islet function and regeneration were examined 3 weeks later. Plasma glucose levels in 1-month-old rats reached a peak 2 weeks after Px and then declined, while those in 5- and 15-month-old rats reached significant levels as early as the day after Px or 2 days after surgery and continued to increase over the following 3 weeks. Consequently, in contrast to young Px rats, weight loss due to severe diabetes was observed in 5- and 15-month-old Px rats. Plasma glucose responses to intravenous glucose loading (0.5 g/kg body weight) were much greater in older Px rats than in younger rats. There was a marginal insulin response to glucose in 1-month-old Px rats, whereas no insulin response to glucose was observed in older Px animals. The insulin content of the residual pancreas was increased threefold in 1-month-old Px rats, but there was no increase in 5- and 15-month-old Px rats. These data demonstrate that the effect of reducing islet mass is much greater in aged rats than in young rats and that the replicatory capacity of B cells tends to diminish after adulthood has been reached.
Aging↗
Studies on hypertrophic effect of 90% partial pancreatectomy on the stomach in rats.
INTRODUCTION: Stomach changes after major pancreatectomy (Px) are unclear. We previously reported that 90% Px increased stomach weight in rats similarly to endogenous hypergastrinemia by lansoprazole, a proton-pump inhibitor. AIM: To investigate the role of endogenous gastrin in gastric hypertrophy after Px. METHODOLOGY: In male Wistar rats, we compared the wet weight of the stomach and serum gastrin levels between normal (n = 10) or sham-operated controls (n = 10) and 90% partially pancreatectomized rats (n = 7). Then, using Northern blot analysis, we compared gene expression of gastrin, cholecystokinin-B (CCK-B) receptor, and somatostatin in the stomach among normal controls (n = 7), sham-operated rats (n = 7), and 90% partially pancreatectomized rats (n = 8). The samples were obtained on the third and seventh postoperative days (POD). RESULTS: Wet weight of the stomach was significantly heavier in the Px rats than in the sham-operated controls (3.90 +/- 0.12 mg/g vs 2.63 +/- 0.07mg/g; p< 0.0001) on the 14th POD. Serum gastrin levels were also higher in the Px rats than in controls (161.4 +/- 13.35 pg/mL vs 110.6 +/- 5.67 pg/mL; p< 0.005) on the 14th POD. Gene expression of gastrin in the stomach on the 7th POD was significantly higher in the Px rats than in the sham-operated rats (p < 0.05), and gene expression of CCK-B receptor clearly increased in the Px rats on the 7th POD, when compared with that of controls (p < 0.05). Gastric somatostatin gene expression in both operated groups increased approximately twice as much as in normal controls after operation (p < 0.005). However, on the 7th POD, it returned to control levels only in Px rats and not in sham-operate rats (p < 0.05). CONCLUSION: Increased gene expression of gastrin and CCK-B receptor suggests that gastrin may act as a trophic factor on the stomach after partial Px. Moreover, the relative decrease in gastric somatostatin gene expression may also influence gastric hypertrophy after Px.
Animals↗