Surgery can provide effective pain relief and improve quality of life for patients with chronic pancreatitis (CP). Common indications for surgery include intractable pain, complications like biliary or duodenal obstruction, and pancreatic head masses that are difficult to differentiate from cancer. Surgical options range from drainage procedures that preserve pancreatic tissue to resection procedures like pancreaticoduodenectomy. While resection can address pain and complications, drainage procedures better preserve endocrine and exocrine function but often lead to recurrent pain. Overall, surgery improves pain control and quality of life for appropriately selected CP patients.
Devascularization in portal hypertension.dr quiyumMD Quiyumm
role of surgery in portal hypertension is promising. Devascularization is one of the procedure of choice in unshuntable portal vein. Though LT is treatment of choice
chronic pancreatitis , from its etiology, types, etiopathology, clinical features to management including surgical and pancreatitic enzymes supplementation. particularly the pain and surgical management are highlighted with pictures.
Devascularization in portal hypertension.dr quiyumMD Quiyumm
role of surgery in portal hypertension is promising. Devascularization is one of the procedure of choice in unshuntable portal vein. Though LT is treatment of choice
chronic pancreatitis , from its etiology, types, etiopathology, clinical features to management including surgical and pancreatitic enzymes supplementation. particularly the pain and surgical management are highlighted with pictures.
Revised Atlanta classification of Acute PancreatitisDr M Venkatesh
The most important change in Atlanta classification is the categorization of the various pancreatic collections.
In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
pseudocysts
In necrotizing pancreatitis,a collection without an enhancing capsule is called an ANC (usually in the first 4 weeks) and thereafter a WON, which has an enhancing capsule.
The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
The classic technique of PD consists of the en-bloc removal of the distal segment of the stomach (antrum), the first and the second portions of the duodenum, specifically the head of the pancreas, the distal CBD, and the gallbladder. Another approach to this procedure is known as the pylorus-sparing PD. In this approach, a small segment of the duo denum is left in situ with the entire stomach to preserve the pylorus and prevent the post–gastrectomy-related symptoms and complications. The classic Whipple and the pylorus-preserving operations are associated with comparable operation times, blood loss, hospital stays, mortality, morbidity, and the incidence of delayed gastric emptying (Mathur et al., 2015). The overall long-term and the disease-free survival is comparable in both groups.
Introduction: Endoscopic RetrogradeCholangiopancreatography (ERCP) has been advocated as a less invasive therapeutic
intervention for the diagnosis and management of various pancreaticobiliary diseases in the aging population. However, the procedure is not without risk. Published literatures have shown different adverse outcomes with the oldest patient documented to be at 97-years-old. This case report of a 99 years and 107 days old male is probably one of the oldest to be recorded to undergo ERCP worldwide, hence is a vital addition to current practice.
Revised Atlanta classification of Acute PancreatitisDr M Venkatesh
The most important change in Atlanta classification is the categorization of the various pancreatic collections.
In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
pseudocysts
In necrotizing pancreatitis,a collection without an enhancing capsule is called an ANC (usually in the first 4 weeks) and thereafter a WON, which has an enhancing capsule.
The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
This is very important topic for Laparoscopic surgeons,as bile injury is not uncommon,how to approach such biliary injuries is prime to know for evolving surgeons.This slide would also helpful for surgery residents.
The classic technique of PD consists of the en-bloc removal of the distal segment of the stomach (antrum), the first and the second portions of the duodenum, specifically the head of the pancreas, the distal CBD, and the gallbladder. Another approach to this procedure is known as the pylorus-sparing PD. In this approach, a small segment of the duo denum is left in situ with the entire stomach to preserve the pylorus and prevent the post–gastrectomy-related symptoms and complications. The classic Whipple and the pylorus-preserving operations are associated with comparable operation times, blood loss, hospital stays, mortality, morbidity, and the incidence of delayed gastric emptying (Mathur et al., 2015). The overall long-term and the disease-free survival is comparable in both groups.
Introduction: Endoscopic RetrogradeCholangiopancreatography (ERCP) has been advocated as a less invasive therapeutic
intervention for the diagnosis and management of various pancreaticobiliary diseases in the aging population. However, the procedure is not without risk. Published literatures have shown different adverse outcomes with the oldest patient documented to be at 97-years-old. This case report of a 99 years and 107 days old male is probably one of the oldest to be recorded to undergo ERCP worldwide, hence is a vital addition to current practice.
Comments Excellent paper. It’s obvious that you put quite a bit of .docxdrandy1
Comments: Excellent paper. It’s obvious that you put quite a bit of work into this. Unfortunately, your paper needs adequate citations in the body of the text to meet our standards on plagiarism. You need to cite each textbook from your bibliography whenever you quote or use some information from the textbook or other resource. For example, writing (Jones 285) after the quote or information used means that you got it from the book whose author was Jones and the info came from page 285.
Laparoscopic cholecystectomy is a procedure in which laparoscopic techniques remove the gallbladder. It is the standard of care for symptomatic gallbladder disease, of which most are performed for symptomatic cholelithiasis. Other indications include acute cholecystitis, biliary dyskinesia, and gallstone pancreatitis.
Describe the reasons a patient might have the selected surgical procedure
The typical reason a cholecystectomy is a treatment of choice is inflammatory changes of gallbladder or blockage of bile flow by gallstones. Symptomatic cholelithiasis is the most common reason where gallstones in the gallbladder are blocking the bile flow and cause inflammation. The patient usually complains of episodic epigastric pain and right upper quadrant pain that radiates to the right shoulder. This pain is found to occur several hours after heavy meals and the patient experiences nausea, vomiting, bloating, fever, and right upper quadrant tenderness. Another condition is acute cholecystitis, where inflammation and symptoms are more prominent. The patient may have a fever, constant pain, positive Murphy's sign, or leukocytosis. Acute cholecystitis may be caused by calculous biliary tract disease with confirmed gallstones in the abdominal US. Acute acalculous cholecystitis usually occurs in critically ill patients, those with prolonged total parenteral nutrition, and some immunosuppressed patients. Patients with episodes of right upper quadrant pain (which are ‘classic' for biliary pain without evidence of cholelithiasis of US or ERCP) may also be referred for laparoscopic cholecystectomy. Gallstone pancreatitis (when small stones pass through the cystic duct) confirmed by cholangiography is another indication for laparoscopic cholecystectomy.
Describe the reasons a patient might be disqualified for this surgery and the options for the patient if any
A patient might be excluded for laparoscopic cholecystectomy due to acute general conditions that are a contraindication for any surgery such as an acute cardiac failure, uncontrolled hypertension, acute renal failure, pneumonia, etc. The condition should be treated by a primary care provider or specialist and the patient should be stable prior surgery. Additional contraindications may include the inability to tolerate general anesthesia, significant portal hypertension, uncorrectable coagulopathy, and multiple prior operations.
List the diagnostic tests and lab work that an attending surgeon might order and desc.
Comments Excellent paper. It’s obvious that you put quite a bit of .docxcargillfilberto
Comments: Excellent paper. It’s obvious that you put quite a bit of work into this. Unfortunately, your paper needs adequate citations in the body of the text to meet our standards on plagiarism. You need to cite each textbook from your bibliography whenever you quote or use some information from the textbook or other resource. For example, writing (Jones 285) after the quote or information used means that you got it from the book whose author was Jones and the info came from page 285.
Laparoscopic cholecystectomy is a procedure in which laparoscopic techniques remove the gallbladder. It is the standard of care for symptomatic gallbladder disease, of which most are performed for symptomatic cholelithiasis. Other indications include acute cholecystitis, biliary dyskinesia, and gallstone pancreatitis.
Describe the reasons a patient might have the selected surgical procedure
The typical reason a cholecystectomy is a treatment of choice is inflammatory changes of gallbladder or blockage of bile flow by gallstones. Symptomatic cholelithiasis is the most common reason where gallstones in the gallbladder are blocking the bile flow and cause inflammation. The patient usually complains of episodic epigastric pain and right upper quadrant pain that radiates to the right shoulder. This pain is found to occur several hours after heavy meals and the patient experiences nausea, vomiting, bloating, fever, and right upper quadrant tenderness. Another condition is acute cholecystitis, where inflammation and symptoms are more prominent. The patient may have a fever, constant pain, positive Murphy's sign, or leukocytosis. Acute cholecystitis may be caused by calculous biliary tract disease with confirmed gallstones in the abdominal US. Acute acalculous cholecystitis usually occurs in critically ill patients, those with prolonged total parenteral nutrition, and some immunosuppressed patients. Patients with episodes of right upper quadrant pain (which are ‘classic' for biliary pain without evidence of cholelithiasis of US or ERCP) may also be referred for laparoscopic cholecystectomy. Gallstone pancreatitis (when small stones pass through the cystic duct) confirmed by cholangiography is another indication for laparoscopic cholecystectomy.
Describe the reasons a patient might be disqualified for this surgery and the options for the patient if any
A patient might be excluded for laparoscopic cholecystectomy due to acute general conditions that are a contraindication for any surgery such as an acute cardiac failure, uncontrolled hypertension, acute renal failure, pneumonia, etc. The condition should be treated by a primary care provider or specialist and the patient should be stable prior surgery. Additional contraindications may include the inability to tolerate general anesthesia, significant portal hypertension, uncorrectable coagulopathy, and multiple prior operations.
List the diagnostic tests and lab work that an attending surgeon might order and desc.
Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.
Methods: A retrospective study was conducted at surgical pediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.
Information about Gerd surgical management by Dr Dhaval Mangukiya.
Details of both sides of Gerd, Introduction, Surgical Anatomy, Hiatus Hernia, Esophageal dearance, Investigation etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemiaguestd58ac53
Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Juza Chen and Avi Bery
Director of Sexual Dysfunction Clinic
Department of Urology
Tel-Aviv Sourasky Medical Center
Sackler Faculty of Medicine Tel-Aviv University
Moscow 2010
Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized histologically by peribiliary inflammation and fibrosis.
It can lead to end stage cirrhosis and is a recognized risk factor for hepatobiliary cancers
A fibroscan is a test used to help measure the amount of scarring (fibrotic tissue) in the liver. It’s essentially a specialized ultrasound specifically for the liver
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Sugery for chronic pancreatitis.dr quiyum
1. Surgery for Chronic Pancreatitis
Prof.Bidhan C DAS
Professor
Dept. of HBP & LTx
BSMMU, Bangladesh
2. With increasing understanding of the pathophysiology of
CP, various therapeutic modalities have evolved over the
last few decades. In addition to pharmacological and
endoscopic modalities, the surgical drainage and resection
procedures are increasingly being performed.
When indicated, surgery can address wide range of clinical
problems associated with CP and has the potential to
provide a durable and adequate pain relief and
improvement in the QOL
Introduction
3. Indications for Surgery
1. Intractable pain remains the commonest indication.
2. Established indications are complications of CP
a. biliary obstruction and duodenal obstruction
b. symptomatic pseudocysts
c. internal pancreatic fistulae or pancreatic ascites that fail to
resolve after adequate conservative or endoscopic treatment.
d. symptomatic portal hypertension subsequent to splenic or portal
vein thrombosis
e. bleeding pseudoaneurysms
f. pancreatic head mass or suspicion of malignancy.
3. controversial indications for surgery are prevention of exocrine or
endocrine deficiency.
4. To provide durable pain relief
To preserve endocrine and exocrine functions.
To prevent complications related to CP
(presence of inflammatory head mass; associated complications such
as biliary obstruction, duodenal stenosis and pseudocysts, gastrointestinal
bleed or established portal hypertension need careful selection).
Inflammatory head mass of CP is often difficult to differentiate from
malignancy, both preoperatively by radiological investigation or during
surgery. Negative tissue diagnosis may be due to known peritumoral
desmoplasia. Although resectional procedures such as
pancreaticoduodenectomy (PD) can solve such issues, the selection of such
radical procedures for head mass of uncertain potential remains a difficult
decision.
Aim of Surgery
8. •Berne modification of Beger procedure
•Hamburg’s modification of Frey procedure
(resection of the head of the pancreas along with
the uncinate process)
Modified Procedures
9. Figure 1. Schematic drawing of duodenum‐preserving pancreatic head resection (DPPHR)
procedures. Extent of resection is shown for Beger's operation (1a) and Frey's operation (2a),
as well as the Berne modification (3a). The lower panels (1b, 2b, 3b) show the corresponding
surgical sites after reconstruction.
11. The diameter of the MPD varies from 3 to 5 mm.
Most consider duct size of at least 8 mm sufficient to justify a PJ,
whereas others regard a duct size of 5 mm as the limit to perform a
drainage operation.
Recently Izbicki has described longitudinal V-shaped excision of the
ventral aspect of the pancreas combined with an LPJ sewn to the capsule
of the pancreas. It has the potential to address the rare cases of sclerosing
ductal pancreatitis or ‘small duct disease’ with MPD diameter of less
than 3 mm
Drainage Procedure and Dilated MPD
12. Surgical decompression reduces intraductal or
pancreatic parenchymal hypertension and is
possibly one of the main reasons for pain in CP.
Preserve the pancreatic parenchyma
Rationale for Drainage Procedures
13. Mortality below 5%
Short-term pain relief is about 80%, especially in patients with dilated MPD.
Exocrine and endocrine functions are well preserved after surgery, since the
loss of functional pancreatic tissue is minimal, but overall improvement in
these parameters are debatable .
Ongoing inflammation may continue despite surgery, which can eventually
lead to gland destruction.
Long-term follow-up of these patients suggests that the pain often recurs
over the period of time and approximately 40% of them complain of pain
2 years after surgery.
In addition, the manifestations of biliary or duodenal stricture become
evident more often in large duct CP which further limits the application of
pure drainage procedures.
Outcome of drainage operation
14. Although too radical for CP, these procedures at the same time
can deal with the associated complications such as common
bile duct stenosis, duodenal stenosis and internal pancreatic
fistulae. Pancreatic head mass with suspicion of malignancy is
best addressed by PD.
Rationale for Resectional Procedures
15. PD : reasonable short-term pain relief, pancreatic head-related
complication can be dealt with simultaneously.
Disappointing endocrine and exocrine functions as compared with other
resection procedures. Thus, PD is no longer a preferred choice in
patients with CP.
PpPD : comparable long-term pain relief, nutritional status, incidences
of diabetes mellitus and need of enzyme supplementation after surgery.
It showed higher incidences of delayed gastric emptying.
Beger procedure (DPPHR): related mortality varies from 0% to 2%
and the morbidity between 15% and 54%. At 5 years of follow-up, pain
relieve is noticed in around 80% of patients and endocrine as well
exocrine functions are well preserved.
Outcome of resectional operation
16. Since the advancement in the endoscopic instrumentations, there
has been emergence of endoscopic therapy for the management of
pain in CP. Several reports have suggested that endoscopic
therapy aimed at decompressing an obstructed pancreatic duct can
be associated with pain relief.
Few studies have compared endoscopic approaches with surgery.
A recent randomized controlled Dutch trial compared
endoscopic therapy with surgical drainage and suggested that
surgical drainage was more effective in relieving
obstruction and achieving pain relief then
endoscopic decopression.
However, most centres still attempt endoscopic therapy prior to
surgery unless there is suspicion for pancreatic cancer possibly
due to referral biases.
Surgery vs Endotherapy
17. Data of celiac ganglion neurolysis for the management of pain in CP are
limited and the exact role is not clear. Endoscopic ultrasound-guided
procedure has shown reasonable success and is considered least invasive
and relatively safe. One-third to half of these patients have shown good
reduction of pain in a short-term follow-up; however, only 10% of them
seem to show a benefit at 24 weeks.
Many studies show that the early good results achieved by neuroablative
procedure decline with time elapsed as compared with the durable relief
obtained from conventional surgical procedures.
Over two-thirds of patients would ultimately need surgery again.
Patients who are at a high risk for surgery or deny it and who those
have failed to respond to surgical management can be offered
neuroablative procedure, although larger data are needed to support its
routine role.
Surgery vs Neuroablative Procedures
18. Surgery for CP has evolved towards organ-sparing procedures, preserving
the body and tail of the gland. The need for extensive subtotal or total
pancreatic resection is therefore very limited and should be used as a
treatment of last resort because of the known severe endocrine
insufficiency.
In the small groups of patients undergoing extensive pancreatectomy, an
attempt should be made to preserve islet function by offering them
pancreatic segmental autotransplantation or islet cell autotransplantation.
The functional outcome of the procedure depends on the amount of
residual functional islet cell mass, loss of cells during the transplant
technique used and the success of the procedure itself. Segmental grafts
have shown better long-term function than islet cell autotransplantation;
however, both techniques are evolving and more experience with them is
required. Although a high percentage of these patients eventually need
insulin, diabetes mellitus can be prevented in some and delayed in others.
Most of these diabetics are stable and easier to manage as compared with
the patients undergoing total pancreatectomy and no autotransplant.
Role of Pancreatic Autotransplantation
19. Data on QOL following surgery for CP are sparse and the results are
difficult to interpret for the reason that different and non-specific
questionnaires are used. A recent Dutch report [70] analyzed 155 patients
following surgery for CP using validated questionnaires for a median
follow-up of 5–6 years. A total of 111 resections and 46 drainage
procedures were performed. Fifty-seven patients had major complications,
and the hospital mortality rate was 1–3%. After surgery the number of
patients needing analgesics was reduced (P < 0·001). Alcohol
consumption significantly reduced pain coping mechanisms (P = 0·032).
In general, the QOL after surgery for CP remains poor, owing to pre-
existing lifestyle and comorbidity. Patients selected for a pancreatic duct
drainage procedure have a better postoperative QOL than those
undergoing resectional procedures. Alcohol consumption was associated
with poor ability to cope with pain after surgery
Quality of Life after Surgery for CP