Síndrome de desconexión del conducto pancreático

El síndrome del ducto pancreático desconectado (SDPD) consiste en la disrupción del ducto pancreático principal con pérdida de continuidad entre el remanente pancreático distal viable y el tracto gastrointestinal, generalmente causado por necrosis ductal secundaria a pancreatitis aguda grave. Esto resulta en fuga de fluido pancreático, provocando un curso de enfermedad prolongado y complicaciones. La literatura sobre este tema es limitada, con algoritmos de tratamiento poco claros. Hemos realizado una revisión de la literatura sobre el tema. Revisión en Pubmed y Scielo (2011-2021) de artículos en inglés y español utilizando términos «síndrome del conducto pancreático desconectado», «DPDS» y «páncreas desconectado» encontrando 16 artículos relevantes. Dadas las pocas citas, se revisaron las referencias de estos artículos. Finalmente, revisamos un total de 21 artículos. Entre las referencias encontradas existe 1 metaanálisis, 4 estudios prospectivos y no existen ensayos aleatorizados.

Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the viable upstream pancreatic parenchyma and the gastrointestinal tract, generally caused by ductal necrosis after severe acute necrotizing pancreatitis. This compromised ductal integrity leads to extraductal leakage of pancreatic secretions, causing a prolonged disease course and complications. The existing literature is limited, with unclear therapeutic algorithms. We have performed a review of the literature on DPDS. Review in Pubmed and Scielo (2011-2021) of articles in English and Spanish using the terms "disconnected pancreatic duct syndrome", "DPDS" and "disconnected pancreas" finding 16 relevant articles. Given the few citations, the references of these articles was reviewed. Finally, we found 21 articles. Among them, there is one meta-analysis, 4 prospective studies and no randomized trials.

Complicaciones pospancreatoduodenectomía de tumores periampulares en una unidad de cirugía hepatopancreatobiliar / Post pancreaticoduodenectomy complications of periampullary tumors in a hepatopancreatobiliary surgery unit

Resumen Introducción: Los tumores periampulares se definen como lesiones ubicadas en un radio de 2 cm alrededor de la ampolla de Vater, constituidos por 4 tipos de neoplasias con una alta tasa de malignidad que pueden originarse en páncreas, ampolla, vía biliar distal o duodeno. El manejo quirúrgico a través de la pancreatoduodenectomía sigue siendo la mejor elección en términos de resección curativa. Objetivo: Caracterizar los tumores peri-ampulares tratados en nuestra institución y que fueron llevados a pancreatoduodenectomía, asociando la relación entre tipo de tumor y complicaciones posoperatorias. Material y Método: Estudio transversal, retrospectivo y observacional con seguimiento a 45 pacientes sometidos a pancreatoduodenectomía en el Hospital Internacional de Colombia - Fundación Cardiovascular entre enero de 2011 y marzo de 2020 con diagnostico histopatológico de tumor peri-ampular. Resultados: Se realizaron 75 pancreatoduodenectomía de las cuales 45 pacientes presentaron tumor peri-ampular, siendo de origen pancreático en un 44%, seguido de ampolla 40%, vía biliar distal 8,8% y duodenal 6,6%. Las complicaciones posoperatorias más frecuentes fueron fístula pancreática y vaciamiento gástrico retardado. Falleció 1 paciente. Conclusión: La pancreatoduodenectomía es un procedimiento con alta morbilidad. Gracias al avance tecnológico, el diagnóstico de patología peri ampular es cada vez más exacto. El tipo de tumor peri-ampular puede influir no solo en su pronóstico, sino también en su morbilidad posquirúrgica.

Introduction: Periampullary tumors are defined as lesions that are located in a radius of 2 centimeters around the ampulla of Vater, constituted by 4 types of neoplasms with a high rate of malignancy originated in the pancreas, ampulla, distal bile duct or duodenum. Surgical management through the pancreatoduodenectomy remains the best choice in terms of curative resection. Objetive: To characterize periampullary tumors treated in our institution with pancreatoduodenectomy, associating the relationship between tumor type and postoperative complications. Material and Method: Cross-sectional, retrospective, observational study with a follow-up of 45 patients underwent pancreatoduodenectomy in the Hospital Internacional de Colombia - Fundación Cardiovascular between January 2011 and March 2020 with histopathological diagnosis of periampullary tumor. Results: Were performed 75 pancreatoduodenectomies, 45 patients presented with Periampullary tumor, 44% being of pancreatic origin, followed by ampulla 40%, distal bile duct 8.8% and duodenal 6.6%. Most frequent postoperative complications were pancreatic fistula and delayed gastric emptying. Mortality was of 1 patient. Conclusión: Pancreatoduodenectomy is a procedure with a high morbidity rate. Thanks to technological advances, the diagnosis of periampullary pathology is increasingly accurate. The type of periampullary tumor may influence not only in its prognosis, but also in its post-surgical morbidity.

"Liver and pancreas oriented" strategies for minimally invasive surgery of biliary malignant tumors / 中华外科杂志

Surgery of biliary malignant tumors is highly related to the liver and pancreas. The "Liver and pancreas oriented" characteristics are unavoidable challenges when formulating surgical strategies. In the development of minimally invasive surgery for biliary malignant tumors, a comprehensive understanding of the pattern of the biliary surgery can make innovation possible. Both the bleeding prevention in hepatectomy and the exposure in pancreatic surgery are the core of minimally invasive surgery for biliary malignant tumors. The relationships between the minimally invasive surgery and the open surgery, laparoscopic and robotic surgery, the biliary tumors and adjacent liver and pancreas are essential to the surgical the progress of the minimally invasive biliary surgery.

Disección del proceso uncinado y mesopáncreas como paso inicial durante la duodenopancreatectomía cefálica: adaptación de un procedimiento laparoscópico / Open pancreatoduodenectomy with initial dissection of the uncinate process and mesopancreas: adaptation from a laparoscopic procedure

Usualmente cuando un procedimiento laparoscópico es realizado, los pasos utilizados en la cirugía abierta son adaptados o modificados con la intención de hacerlo factible desde el punto de vista laparoscópico, la presentación de esta técnica quirúrgica demuestra la situación inversa. La disección de manera inicial del proceso uncinado pudiera permitir una mejor exposición de los vasos mesentéricos superiores y dirigir una correcta disección linfática y neurovascular del tejido conocido como mesopáncreas, con el propósito de obtener un mayor porcentaje de resecciones R0. Es así como se expone la técnica quirúrgica utilizada en un caso clínico(AU)

When a laparoscopic procedure is done, the surgical steps are adapted from open surgery in order to make it feasible, in this case presentation it shows the inverse situation. The dissection of the uncinate process and the neurovascular tissue known as mesopancreas, at the first steps in surgery could achieve better results for negative margins. The paper ilustrate the surgical technique performed in a clinical case presentation(AU)

Analysis and treatment of intra-abdominal infectious after pancreatic surgery / 中华肝胆外科杂志

Objective To study the bacterial types and their drug resistance in intra-abdominal infections after pancreatic surgery,and to evaluate the appropriate treatment measures.Methods 113 patients who underwent pancreatic surgery from Jan 2012 to Dec 2012 in our hospital were included into this study.The drainage liquid from the surgical sites were collected for bacterial culture and drug susceptibility tests.Results The incidence of intra-abdominal infections was 39.8％ (45/113).There were 54 pathogenic strains of bacteria isolated,including 49 strains of gram-negative bacteria (90.7％),4 strains of gram-positive bacteria (7.4％),and 1 strain of fungus (1.9％).The top three pathogens were Pseudomonas aeruginosa (50.0％),Acinetobacter baumannii (14.8％) and Singular deformation bacteria (1 1.1％).Most gram-negative bacteria were sensitive to Polymyxin B and Aminoglycoside antibiotics (＞ 70％),but they were resistant to Imipenem and Cephalosporin which were commonly administered.Pancreatic fistula was closely related to intra-abdominal infections.Concluusions A gram-negative bacteria,Pseudomonas aeruginosa,was the predominant organism in intra-abdominal infections after pancreatic surgery in our hospital.The situation of drug-resistance was still severe.More effective measures should be taken to prevent growth of resistant strains such as using antibiotics according to drug sensitivity and avoiding empirical single use of broad-spectrum antibiotics.Pancreatic fistula commonly led to intra-abdominal infections.

Tratamento cirúrgico da pancreatite crônica com a técnica de F rey: panorama atual / Surgical treatment of chronic pancreatitis with frey procedure: current situation

INTRODUÇÃO: A pancreatite crônica é desordem inflamatória progressiva caracterizada pela destruição irreversível do parênquima pancreático, podendo estar associada à dor crônica incapacitante e perda permanente da função endócrina e exócrina. A principal indicação cirúrgica é a dor abdominal intratável e a escolha da melhor técnica a ser empregada permanece um desafio. A técnica descrita por Frey conseguiu combinar a eficácia no controle da dor das operações de ressecção com as baixas taxas de mortalidade e morbidade das derivativas. OBJETIVO: Comparar e discutir os resultados do tratamento cirúrgico da pancreatite crônica com a técnica de Frey. MÉTODOS: Revisão bibliográfica de 276 artigos científicos disponíveis no Medline/Pubmed e no banco de dados de teses nacionais com os descritores pancreatite crônica, tratamento cirúrgico e cirurgia de Frey. Foram selecionados os 30 artigos de maior importância e que relataram maior experiência com esta opção cirúrgica. CONCLUSÕES: A técnica de Frey demonstra ser opção de alta efetividade no controle da dor abdominal secundária à pancreatite crônica no longo prazo naqueles pacientes com dor abdominal incapacitante e aumento volumétrico da cabeça pancreática, com menores taxas de morbidade e mortalidade. Os estudos demonstraram pequena interferência da técnica na deterioração das funções endócrina e exócrina.

INTRODUCTION: Chronic pancreatitis is a progressive inflammatory disorder characterized by irreversible destruction of pancreatic parenchyma and may be associated with disabling chronic pain and permanent loss of endocrine and exocrine function. Main indication for surgery is intractable abdominal pain and choosing the best technique to be used for a patient remains a challenge. The technique described by Frey combines the effectiveness of pain control characteristic of resection surgery with low mortality and morbidity of derivative procedures. AIM: To compare and discuss the results of surgical treatment of chronic pancreatitis with Frey procedure. METHODS: A literature review of scientific articles available in Medline/Pubmed database and the national theses descriptors with terms chronic pancreatitis, surgical treatment and Frey procedure. It was selected the most important articles and that reported more experience with this surgical option. CONCLUSIONS: Frey procedure proves to be an option with high effectiveness in controlling abdominal pain secondary to chronic pancreatitis in the long term in patients with abdominal pain and enlarged pancreatic head, with lower rates of morbidity and mortality. The studies showed little interference of technique in the deterioration of endocrine and exocrine pancreatic functions.

Relationship Between the Perioperative Status and Prognosis after Pancreaticoduodenectomy / 中国普外基础与临床杂志

342 ?mol/L and ≤342 ?mol/L, the incidence of total complications increased evidently (P

Pylorus-preserving Whipple Pancreaticoduodenectomy: CT Findings of Immediate Postoperative Complications

PURPOSE: To determine the CT findings of immediately postoperative complications including anastomoticleakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications ofpylorus preserving Whipple pancreaticoduodenectomy (PPPD) MATERIALS AND METHODS: During the early postoperativeperiod, fluid accomulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, thetime interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, wecompared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oralwater-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, thesite of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram viapercutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluidcollections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case withsix patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six,this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomoticleakage. RESULTS: Eight patients showed intra-abdominal fluid collections due to leakage at anastomotic sites: infive, this was the site of pancreaticojejunostomy, and in three, that of choledochojejunostomy. One patient showeda right subphrenic abscess, and another, a loculated fluid collection between the jejunal loops, without leakageat the anastomotic site. CT scans in all three cases with leakage at the site of choledochojejunostomy showed thesmall collection of fluid to be relatively well demarcated and confined to the areas of lesser sac or gallbladderbed. In four of five cases of leakage at the site of pancreaticojejunostomy, the large collection of fluid waswidespread; it occupied areas which included the perihepatic and peripancreatic space, as well as the paracolicgutters and pelvic cavity. CONCLUSION: In some cases of suspected complications arising after PPPD, and includinganastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in suchcases, CT scanning may help detect the complications and determine the site of anastomotic leakage.

Nosocomial Infection in Pancreas Surgery:An Investigation and Analysis / 中华医院感染学杂志

OBJECTIVE To investigate status of nosocomial infection in pancreas surgery of our hospital.METHODS The inpatient cases of pancreas surgery from Jan to Dec 2005 were prospectively and retrospectively surveyed.RESULTS Of the nosocomial infections,surgical site infection and the pulmonary infection were very prominent(78.2%),of the isolated strains the rate of bacterial pathogens was 85.90% and the rate of fungi was 14.10%,all strains were human normal intestinal bacterial species,the highest rate of infection was from patients with severe pancreatitis(29.41%),the pancreas surgery had higher multiple infection proportion(38.78%).CONCLUSIONS Rational application of antibiotic,intraoperative aseptic manipulation,short time operation,unobstructed drainage,prevention and timely treatment of pancreatic fistula and intraperitoneal hemorrhage,are the effective measures for the patients with pancreas surgery.