Surgical Management of Chronic Pancreatitis at the Mayo Clinic
Section snippets
PATHOPHYSIOLOGIC CONSIDERATIONS IN THE ETIOLOGY OF PAIN IN CHRONIC PANCREATITIS
Pain is the most common clinical presentation and primary indication for surgical intervention in chronic pancreatitis.20 The etiopathogenesis of pain seems to be multifactorial and complex. Two complementary theories offer a physiologic basis for surgical treatment in chronic pancreatitis: (1) the pancreatic compartment theory and (2) the neural inflammation theory.
PRESURGICAL EVALUATION
Many factors must be considered in the presurgical evaluation of patients with chronic pancreatitis, including not only the pancreatic and peripancreatic anatomy but also concomitant psychosocial concerns.
SURGICAL DECISION MAKING
The type of surgical approach suggested depends on a combination of anatomy (i.e., inflammatory mass, dominant disease, and a dilated pancreatic or bile duct), comorbidity, presence of chemical dependence, and psychosocial considerations. All of these variables are potentially important in the decision-making process. The types of surgical intervention available in the management of chronic pancreatitis include primary ductal drainage procedures, either formal anatomic pancreatic resections
SUMMARY
The authors' approach to the overall surgical management of chronic pancreatitis is to treat complications, that is, pain and, less commonly, obstruction and bleeding. The authors' practice is to exhaust nearly all forms of nonsurgical intervention before suggesting a surgical approach. Nonresponders are then evaluated for severity of pain, interference of quality of life, and presence of chemical dependency. Appropriate candidates undergo imaging examinations to determine the primary site of
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Cited by (21)
International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis
2020, PancreatologyCitation Excerpt :This threshold of 5 mm could be proposed as definition of a “dilated main duct”. Different thresholds used in studies to define a dilated main duct in CP, ranging from 3 mm by Izbicki et al. to 8 mm by Nealon et al. [22,26,29,37,53–61] However, in most of the recent studies, a pancreatic duct of more than 5 mm is defined as dilated (Table S3). In the literature published from 1993, patients with dilated pancreatic main duct and documented normal size pancreatic head were mainly treated by a lateral pancreaticojejunostomy (Table S4) [16,26,53,54,57,59,60,62–74].
Palliation of Pancreatic Ductal Obstruction in Pancreatic Cancer
2013, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :It is mainly located in the epigastrium or left hypochondrium, and occasionally radiates to the back, lasting 1 to 2 hours.10 This pain is similar to that which occurs in large duct chronic pancreatitis (CP).11,12 CP with pain is characterized by poor vascularity with severe periductal and arterial fibrosis.13
Autologous Islet Cell Transplantation
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Address reprint requests to Michael G. Sarr, MD. Gastroenterology Research Unit (AL 2-435). Mayo Clinic. 200 First Street SW. Rochester, MN 55905
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Department of Surgery, Division of General and Gastroenterologic Surgery, Mayo Clinic, Rochester, Minnesota