Surgery
Volume 148, Issue 4 , Pages 847-857 , October 2010

Clinical framework to guide operative decision making in disconnected left pancreatic remnant (DLPR) following acute or chronic pancreatitis

Presented at the 67th Annual Meeting of the Central Surgical Association, Chicago, Illinois, March 10–13, 2010.

  • Kariuki P. Murage, MD

      Affiliations

    • Departments of Surgery and Radiology, Indiana University School of Medicine, Indianapolis, IN
  • ,
  • Chad G. Ball, MD

      Affiliations

    • Departments of Surgery and Radiology, Indiana University School of Medicine, Indianapolis, IN
  • ,
  • Nicholas J. Zyromski, MD

      Affiliations

    • Departments of Surgery and Radiology, Indiana University School of Medicine, Indianapolis, IN
  • ,
  • Attila Nakeeb, MD

      Affiliations

    • Departments of Surgery and Radiology, Indiana University School of Medicine, Indianapolis, IN
  • ,
  • Carlos Ocampo, MD

      Affiliations

    • Department of Surgery, Hospital Cosme Argerich, Buenos Aires, Argentina
  • ,
  • Kumaresan Sandrasegaran, MD

      Affiliations

    • Departments of Surgery and Radiology, Indiana University School of Medicine, Indianapolis, IN
  • ,
  • Thomas J. Howard, MD

      Affiliations

    • Departments of Surgery and Radiology, Indiana University School of Medicine, Indianapolis, IN
    • Corresponding Author InformationReprint requests: Thomas J. Howard, MD, Emerson Hall No. 517, 545 Barnhill Drive, Indianapolis, IN 46202.

,Accepted 15 July 2010.

References 

  1. Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002;2:565–573
  2. Werner J, Feurerbach S, Uhl W, Büchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005;54:426–436
  3. Howard TJ, Rhodes GF, Selzer DJ, Sherman S, Fogel E, Lehman GA. Roux-en-Y internal drainage is the best surgical option to treat patients with the disconnected duct syndrome following severe acute pancreatitis. Surgery. 2001;130:714–721
  4. Strasberg SE, McNevin MS. Results of a technique of pancreaticojejunostomy that optimizes blood supply to the pancreas. Surg Gynecol Obst. 1998;187:591–596
  5. Sandrasegaran K, Tann M, Jennings SG, Maglinte DD, Peter SD, Sherman S, et al. Disconnection of the pancreatic duct: an important but overlooked complication of severe acute pancreatitis. Radiographics. 2007;27:1389–1400
  6. Howard TJ, Moore SA, Saxena R, Matthews DE, Schmidt CM, Wiebke EA. Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis. Surgery. 2004;136:909–916
  7. Howard TJ, Patel JB, Sandrasegaran K, Yu J, Nakeeb A, Pitt HA, et al. Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg. 2007;11:43–49
  8. Sai JK, Suyama M, Kubokawa Y, Watanabe S. Diagnosis of mild chronic pancreatitis (Cambridge classification): comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography. World J Gastroenterol. 2008;14:1218–1221
  9. DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–939
  10. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13
  11. Howard TJ, Cohen SM, Zyromski NJ, Nakeeb A, Schmidt CM, Pitt HA, et al. Persistent pancreatic fistula following necrosectomy: long-term patency of pancreaticojejunostomy and fistulojejunostomy. Gastroenterology. 2007;132(4 Suppl. 2):A-868
  12. Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg. 1993;80:94–99
  13. Pelaez-Luna M, Vege SS, Petersen BT, Chari ST, Clain JE, Levy MJ, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc. 2008;68:91–97
  14. Traverso LW, Kozarek RA. Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg. 2005;9:436–439
  15. Witt H, Apte MV, Keim V, Wilson JS. Chronic pancreatitis: challenges and advances in pathogenesis, genetics diagnosis and therapy. Gastroenterology. 2007;132:1557–1573
  16. Arvanitakis M, Delhaye M, Bali MA, Matos C, De Maertelaer V, Le Moine O, et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc. 2007;65:609–619
  17. Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW. Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology. 1991;100:1362–1370
  18. Tann M, Maglinte D, Howard TJ, Sherman S, Fogel E, Madura JA, et al. Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients. J Comp Assist Tomogr. 2003;27:577–582
  19. Lawrence C, Howell DA, Stefan AM, Conklin DE, Lukens FJ, Martin RF, et al. Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of long-term follow-up. Gastrointest Endosc. 2008;67:673–679
  20. The American heritage dictionary: second college edition. Boston: Houghton, Mifflin & Co; 1982;
  21. Deviere J, Antake F. Disconnected pancreatic tail syndrome: a plea for multidisciplinarity. Gastrointest Endosc. 2008;67:680–682
  22. Howard TJ, Browne JS, Zyromski NJ, Lavu H, Baker MS, Shen C, et al. Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis. J Gastrointest Surg. 2008;12:2087–2095discussion 2095-6
  23. Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg. 2003;238:161–167
  24. King J, Kazanjian K, Matsumoto J, Reber HA, Yeh MW, Hines OJ, et al. Distal pancreatectomy: incidence of postoperative diabetes. J Gastrointest Surg. 2008;12:1548–1553
  25. Sakorafas GH, Sarr MG, Farley DR, Farnell MB. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg. 2000;179:129–133
  26. Heider TR, Azeem S, Galanko JA, Behrns KE. The natural history of pancreatitis-induced splenic vein thrombosis. Ann Surg. 2004;239:876–882
  27. van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and evaluation of intervention in the Netherlands. Ann Surg. 2005;242:781–788discussion 788-90

PII: S0039-6060(10)00407-1

doi: 10.1016/j.surg.2010.07.039

Surgery
Volume 148, Issue 4 , Pages 847-857 , October 2010