Surgical morphology of the pancreatic isthmus.

BACKGROUND: Pancreatic isthmus method anastomosis following pancreatic resection is an important factor of postoperative fistula formation. While the anatomy and vascular supply of the pancreatic head have been studied in detail, little is known about the morphology of the pancreatic isthmus. The authors determine the anatomy and morphology of the pancreatic isthmus. METHODS: 99 consecutive cadaveric pancreatic specimens were taken during standard autopsy. Organs were transected at the isthmus and pancreatograms and microscopic specimens of the transection plane were analyzed. RESULTS: The mean size of the Wirsung duct at the isthmus was 2.89 mm (+/-0.87 mm, from 1.4 to 6 mm). The main pancreatic duct was located approximately in the middle of the pancreatic cross-section plane in almost all specimens. The total number of second-degree pancreatic ducts visible on pancreatograms within the isthmus was 1.77 (+/-1.00, from 0 to 4) and 1.83 (+/-1.4, from 0 to 5) on microscopic analysis. CONCLUSIONS: The presence of second-degree pancreatic ducts at the transection site might favor the use of a pancreaticoenteric anastomosis with stump invagination to reduce the risk of anastomotic leakage. and IAP.

Pancreatic duct diversity.

OBJECTIVES: The formation of the pancreatic duct system is the result of the fusion of 2 embryonic buds, the ventral and dorsal primordia. Frequently, this fusion process is localized in the pancreatic head; variations, however, may account for the structural diversity of the duct system. Pancreatic duct anomalies and diversity of body and tail are thought to be casuistic. METHODS: Ninety-nine consecutive adult autopsies with reference to macroscopic anomalies in the distal part of the gland were evaluated. Pancreatograms were performed after large duodenal papilla cannulation. Ducts parallel to gland axis with a diameter of at least one third of the main pancreatic duct at the junction point and aberrant duct with different shapes and/or abnormal third-degree ductuli architecture were noted. RESULTS: Our study revealed a 9.9% frequency of main pancreatic duct diversity in the pancreatic corpus and tail. Eleven atypical ducts were visible, 9 cranially and 2 caudally from the main pancreatic duct. CONCLUSIONS: The pancreatic duct system in the body and the tail presents abnormal configuration not described in the past.

Biliary versus alcohol-related infected pancreatic necrosis: similarities and differences in the follow-up.

OBJECTIVES: Infected pancreatic necrosis (IPN) is a serious complication of acute pancreatitis. Data concerning survivors' quality of life and pancreatic functions are scarce. Follow-up of the patients with alcohol and biliary etiology of IPN treated with open necrosectomy was performed. METHODS: Twenty-eight survivors after operative treatment (Bradley procedure) of IPN were followed up 24 to 96 months after discharge from the hospital (10 biliary and 18 alcohol patients). Their exocrine and endocrine pancreatic functions and quality of life (Functional Assessment of Chronic Illness Therapy scale) were evaluated. Pancreatic tissue remaining after necrosectomy was visualized by use of contrast-enhanced computed tomography (CT). RESULTS: In 44.4% of alcohol-induced IPN patients, the presence of the whole pancreas was shown on the follow-up CT, contrary to the biliary group, where the partial lack of the pancreas was observed in all cases. Pancreatic tissue calcifications were present on CT in 8 patients of alcohol-induced acute pancreatitis group only. Median stool elastase 1 concentrations were 318.1 U/mL in the biliary group and 238.3 U/mL in the alcohol-induced group (not significant). The Functional Assessment of Chronic Illness Therapy scale showed significantly higher social/family and emotional well-being in patients with biliary acute necrotizing pancreatitis. CONCLUSIONS: Patients after alcohol-induced IPN had lower quality of life compared with biliary etiology. Biliary and alcohol-induced IPN patients after surgical treatment have nonsignificant differences of endocrine and exocrine pancreatic functions.

Pancreatic cross-section: an elliptical model.

BACKGROUND: Pancreatic surgery has developed over the last 60 years. A pancreaticoduodenectomy of the pancreatic head and duodenal papilla is the most common procedure. The most popular pancreatic cross-section site of a pancreaticoduodenectomy is the isthmus of the gland. The pancreatic isthmus anatomical configuration is still being considered. STUDY DESIGN: The authors propose a new parametric descriptive system of pancreatic cross-section based on an elliptical model. RESULTS: The pancreatic cross-section was evaluated as a geometric ellipse and the location of the pancreatic duct was based on coordinates. When analyzing the cross-section plane of the pancreatic isthmus, the mean size of the pancreatic isthmus cross-section was 10.46+/-2.34 mm in width (mean+/-SD) and 25.55+/-4.56 mm in length. The mean vertical/horizontal distance ratio was 0.42+/-0.12. The mean size of the main pancreatic duct was 1.02x2.46 mm. The mean distribution coordinates of the main pancreatic duct were: X 51.23; Y 50.60. CONCLUSIONS: A proportional model of pancreatic isthmus cross-section analysis is easy and effective, and could become a valuable tool in future anatomical studies. The system described allows us to analyze data acquired from several investigators.