1
|
Ferri V, Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Caruso R. Diagnosis and treatment of pancreas divisum: A literature review. Hepatobiliary Pancreat Dis Int 2019; 18:332-336. [PMID: 31155429 DOI: 10.1016/j.hbpd.2019.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis. Recurrent acute pancreatitis, chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5% of the patients with pancreas divisum. This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum. DATA SOURCES We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum. RESULTS There are limited reports available on this topic in the literature. We analyzed and described the main indications in the treatment of pancreas divisum, focusing on surgical treatment and a discussion of the different approaches. Furthermore, we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy (the Nakao procedure). CONCLUSIONS Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease. Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications. Many techniques, of greater or lesser complexity, have been proposed.
Collapse
Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain.
| | - Emilio Vicente
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| |
Collapse
|
2
|
Snajdauf J, Rygl M, Petru O, Nahlovsky J, Frybova B, Durilova M, Mixa V, Keil R, Kyncl M, Kodet R, Whitley A. Indications and outcomes of duodenum-preserving resection of the pancreatic head in children. Pediatr Surg Int 2019; 35:449-455. [PMID: 30386905 DOI: 10.1007/s00383-018-4410-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/23/2022]
Abstract
AIM OF STUDY Duodenum-preserving resection of the pancreatic head (DPRPH) with Roux-en-Y pancreatojejunostomy is a procedure used to remove focal pathological lesions of the pancreatic head. Although predominantly used in adult patients, it is both safe and effective in children. The aim of this study was to review our experience with this procedure, with focus on its indications, complications and long-term outcomes. METHODS A retrospective analysis of pediatric patients who underwent DPRPH between 1994 and 2015 was performed. Patient files were reviewed for demographic, diagnostic, operative and histological details, postoperative complications. Patients were contacted telephonically and sent questionnaires to determine long-term outcomes. RESULTS The study cohort consists of 21 patients, 14 girls and 7 boys, with an average age of 11.72 years (range 3 months to 18.6 years), who underwent DPRPH with end-to-end anastomosis of the jejunum to the pancreatic body (Roux-en-Y anastomosis). In four cases the head and also part of the body of the pancreas was resected. In the remaining 17 cases, only the head of the pancreas was resected. Indications for DPRPH were solid pseudopapillary tumor of the pancreas (n = 10), trauma (n = 8), pancreas divisum (n = 1), focal congenital hyperinsulinism (n = 1) and pancreatic cyst (n = 1). The length of follow-up ranged from 1 to 22 years (average 9.66). One patient developed a biliary fistula, which closed spontaneously within 2 weeks after stent insertion. A recurrence of abdominal pain was reported in two patients, occurring at 7 months after the operation in one patient and at 1 year in the other. Pancreatic endocrine insufficiency did not occur in any of the 21 patients. Seven patients currently require a low fat diet, five of which need pancreatic enzyme supplementation. An additional two patients need enzyme supplementation without dietary restriction. CONCLUSION DPRPH is a safe and effective procedure for the treatment of large focal pathological lesions of the pancreatic head in children. As a less invasive procedure than pancreatoduodenectomy, it is more appropriate for the developing child.
Collapse
Affiliation(s)
- Jiri Snajdauf
- Department of Pediatric Surgery, Institute of Postgraduate Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Ondrej Petru
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jiri Nahlovsky
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
| | - Barbora Frybova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Marianna Durilova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimir Mixa
- Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Radan Keil
- Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Roman Kodet
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Department of Anatomy, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
3
|
Lee JW, Choi SH, Chon HJ, Kim DJ, Kim G, Kwon CI, Ko KH. Robotic transduodenal ampullectomy: A novel minimally invasive approach for ampullary neoplasms. Int J Med Robot 2019; 15:e1979. [PMID: 30578741 DOI: 10.1002/rcs.1979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The adoption of minimally invasive surgery for transduodenal ampullectomy has been slow because of special characteristics and complexity of this procedure. METHODS Six patients underwent robotic transduodenal ampullectomy. We employed novel methods to facilitate exposure of the ampulla. RESULTS All patients completed robotic transduodenal ampullectomy, but one patient was immediately converted to robotic pancreaticoduodenectomy because of presence of invasive carcinoma on frozen biopsy. The final pathologic report revealed high-grade dysplasia in four patients, low-grade dyplasia in one, and T2N0 in one patient who converted to pancreaticoduodenectomy. There was no immediate postoperative complication or mortality. One patient was readmitted after 3 months because of stricture of the bile duct outlet. There was no recurrence over a median follow-up period of 20 months. CONCLUSION An appropriate combination of patient positioning and retraction method helps the robot surgical system to provide competent performance for sophisticated and precise manipulation of ampullary lesions.
Collapse
Affiliation(s)
- Jin Woo Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sung Hoon Choi
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hong Jae Chon
- Medical oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Dae Jung Kim
- Radiolgy, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Gwangil Kim
- Pathology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Chang Il Kwon
- Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Kwang Hyun Ko
- Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| |
Collapse
|
4
|
A systematic review and quantitative analysis of different therapies for pancreas divisum. Am J Surg 2017; 214:525-537. [PMID: 28110914 DOI: 10.1016/j.amjsurg.2016.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pancreas divisum is the most common anatomical variation of pancreatic ductal system affecting 5-10% of population. Therapy includes different endoscopic and surgical procedures. The aim of this article was to summarize actual evidence of different treatment. METHODS A Medline search was performed to identify all studies, investigating endoscopic or surgical therapy of Pancreas divisum. An individual data simulation model was applied to compare endoscopic and surgical studies. RESULT 56 observational studies (31 endoscopic and 25 surgical studies) were included in analyses. Surgery was significantly superior to endoscopic treatment in terms of success rate (72% vs. 62.3), complication rate (23.8% vs. 31.3%) and re-intervention rate (14.4% vs. 28.3%). CONCLUSION Surgery may be superior to endoscopy in terms of treatment success and complications. There is no study comparing these two therapies. Consequently, a randomized trial is needed to clarify if endoscopy or surgery is superior in the therapy of pancreas divisum.
Collapse
|
5
|
Izzo P, Di Cello P, Pugliese F, Izzo S, Grande R, Biancucci F, Sinaimeri G, Razionale F, Costi U, Al Mansour M, Muneer A, Valabrega S, Izzo L. Pancreas divisum: correlation between anatomical abnormalities and bile precipitation in the gallbladder in seven patients. G Chir 2016; 37:155-157. [PMID: 27938531 DOI: 10.11138/gchir/2016.37.4.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreas divisum is a genetic defect associated with recurrent acute pancreatitis due to insufficient drainage of the accessory pancreatic duct. Seven young patients diagnosed with pancreatic divisum and thickening of the gallbladder bile as shown on magnetic resonance cholangio-pancreatography without pancreatic ductal changes underwent laparoscopic cholecystectomy. During the mean follow-up of 32 months no episode of pancreatitis was reported. There is an association between PD and higher concentration of bile in the gallbladder. Cholecystectomy can be considered curative in patients with PD in the absence of indications for major surgery.
Collapse
|
6
|
Schneider L, Contin P, Fritz S, Strobel O, Büchler MW, Hackert T. Surgical ampullectomy: an underestimated operation in the era of endoscopy. HPB (Oxford) 2016; 18:65-71. [PMID: 26776853 PMCID: PMC4750227 DOI: 10.1016/j.hpb.2015.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/28/2015] [Accepted: 07/10/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Benign neoplastic, inflammatory or functional pathologies of the ampulla of Vater are mainly treated by primary endoscopic interventions. Consequently, transduodenal surgical ampullectomy (TSA) has been abandoned in many centres, although it represents an important tool not only after unsuccessful endoscopic treatment. The aim of the study was to analyse TSA for benign lesions of the ampulla of Vater. PATIENTS AND METHODS All patients who underwent TSA between 2001 and 2014 were included. Patients were analysed in terms of indications, postoperative morbidity and mortality as well as long-term success. RESULTS Eighty-three patients underwent TSA. Indications included adenomas in 44 and inflammatory stenosis in 39 patients. 96% of the patients had undergone endoscopic therapeutic approaches prior to TSA (median no. of interventions n = 3). Postoperative morbidity occurred in 20 patients (24%). There was one procedure-associated death (mortality 1.2%). The mean follow-up was 54 months. Long-term overall success rate for TSA was 83.6%. After TSA for ampullary adenoma, the recurrence rate was 4.5%. CONCLUSION TSA is an underestimated surgical procedure, which can be performed safely with high long-term efficacy. It can be implemented in clinical algorithms for patients with benign pathologies of the ampulla of Vater, particularly after unsuccessful endoscopic treatment.
Collapse
Affiliation(s)
- Lutz Schneider
- Correspondence Markus Büchler, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Tel.: +49 6221 566110. Fax: +49 6221 56 5450.
| | | | | | | | | | | |
Collapse
|
7
|
Paiella S, De Pastena M, Esposito A, Salvia R, Morigi C, Bassi C. Selective agenesis of pancreatic isthmus parenchyma with preservation of main pancreatic duct continuity, a very rare entity: Case report. Int J Surg Case Rep 2014; 6C:169-71. [PMID: 25544484 PMCID: PMC4347963 DOI: 10.1016/j.ijscr.2014.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 12/03/2022] Open
Abstract
Pancreatic congenital anomalies are not infrequent. A rare selective agenesis of pancreatic parenchyma is presented. Neoplastic lesions should always been considered in case of pancreatic congenital anomalies.
Context Agenesis of the dorsal pancreas is a rare anomaly, mostly associated with other medical conditions. It may be complicated with pancreatic neoplasms. Case report We report the case of a 51-year-old male with selective agenesis of pancreatic isthmus with preservation of main pancreatic duct and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with suspicious features of the pancreas. Conclusion This is probably the first report of isolated agenesis of pancreatic isthmus with conservation of main pancreatic duct.
Collapse
Affiliation(s)
- Salvatore Paiella
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy.
| | - Matteo De Pastena
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Alessandro Esposito
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Roberto Salvia
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Consuelo Morigi
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Claudio Bassi
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| |
Collapse
|