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Duodenumerhaltende Pankreaskopfresektion

Technik nach Beger, Technik nach Frey und Berner Modifikation

Duodenum-preserving pancreatic head resection

Technique according to Beger, technique according to Frey and Berne modifications

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Zusammenfassung

Chronische Schmerzen stellen bei der chronischen Pankreatitis (CP) die häufigste Operationsindikation dar. Weil die Symptomatik oft durch eine entzündliche Raumforderung im Pankreaskopf bedingt ist und unterhalten wird, sind resezierende Verfahren reinen Drainageoperationen überlegen. Die Whipple-Operation und die duodenumerhaltende Pankreaskopfresektion (DEPKR) sind sichere sowie effektive Methoden mit einer anhaltenden Schmerzreduktion bei ca. 80% der Patienten. Randomized controlled trials (RCT) zeigen initial funktionelle Vorteile der organerhaltenden DEPKR im Vergleich zur Whipple-Operation, die jedoch im Langzeitverlauf verloren gehen. Dies liegt wahrscheinlich darin begründet, dass ein Fortschreiten des exokrinen und endokrinen Funktionsverlusts durch die Operation nicht verhindert wird. Trotzdem sollte die schonendere DEPKR die Methode der Wahl darstellen. Die von Beger etabliert Technik der DEPKR wurde durch Frey im Sinne einer erweiterten Drainageoperation und durch Büchler im Sinne einer technischen Vereinfachung (Berner Modifikation) verändert. Während die Ergebnisse bezüglich Schmerzreduktion, Lebensqualität und Organfunktion bei den verschiedenen DEPKR-Techniken vergleichbar sind, spricht die technisch einfachere Durchführbarkeit für die Berner Modifikation.

Abstract

In chronic pancreatitis chronic pain is the most frequent indication for surgery. Because symptoms are often caused or maintained by an inflammatory mass in the head of the pancreas, resection procedures are superior to pure surgical drainage. The pancreatoduodenectomy (PD) and the duodenum-preserving pancreatic head resection (DPPHR) are safe and effective techniques resulting in long-lasting pain relief in about 80% of patients. Randomized controlled trials (RCTs) show initial functional advantages for the organ-preserving DPPHR compared to PD, but these advantages are lost during follow-up, most likely because neither operation prevents a progressive loss of exocrine and endocrine function. Nevertheless the less invasive DPPHR should be regarded as the procedure of choice. The technique of DPPHR described by Beger was modified by Frey to an extended drainage procedure with local head excision; the Berne modification offers a technically less demanding option with comparable extent of resection. While results in terms of pain relief, quality of life and organ function are comparable between the three DPPHR techniques, the technical aspect of a simpler procedure favors the Berne modification.

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  1. Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    O. Strobel, M.W. Büchler &  J. Werner

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  1. O. Strobel
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  2. M.W. Büchler
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  3. J. Werner
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Correspondence to J. Werner.

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Strobel, O., Büchler, M. & Werner, J. Duodenumerhaltende Pankreaskopfresektion. Chirurg 80, 22–27 (2009). https://doi.org/10.1007/s00104-008-1577-8

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