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Pankreasanastomosen bei operativer Versorgung der chronischen Pankreatitis

Pancreatic anastomosis in operative treatment of chronic pancreatitis

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Zusammenfassung

Die chronische Pankreatitis (CP) ist ein irreversibler, entzündlicher Prozess, der durch eine progressive Fibrose des Pankreas charakterisiert ist und zu abdominellen Schmerzen sowie exokriner und endokriner Insuffizienz führt. Eine Indikation zur operativen Therapie besteht bei unzureichender Schmerzlinderung und lokalen Komplikationen. Die chirurgische Therapie hat als Ziel, den Pankreas- bzw. Gallengang zu entlasten und fibrotisches/kalzifiziertes Parenchym zu resezieren. Es werden drainierende und resezierende Verfahren unterschieden. Drainierende Verfahren, wie das nach Partington-Rochelle, kommen bei isoliertem Gangaufstau ohne weitere Organkomplikationen wie entzündliche Pankreaskopfprozesse zum Einsatz. Jedoch zeigen Patienten mit CP häufig eine entzündliche Auftreibung im Pankreaskopf mit konsekutivem Gangaufstau. In diesem Fall können die klassische Pankreatoduodenektomie (PD) oder die organsparenden duodenumerhaltenden Pankreaskopfresektionen (DEPKR) mit ihren verschiedenen Techniken (Beger, Frey, Bern, V‑Shape) angewandt werden. Bei vergleichbaren Langzeitergebnissen sollte die PD bei Verdacht oder Nachweis von Malignität durchgeführt werden und die DEPKR zur Therapie der CP.

Abstract

Chronic pancreatitis (CP) is an irreversible, inflammatory process, which is characterized by progressive fibrosis of the pancreas and leads to abdominal pain, endocrine and exocrine insufficiency. Surgical therapy is indicated by the absence of pain relief and local complications. The target of the surgical approach is to relieve the pancreatic and bile ducts and resection of the fibrotic and calcified parenchyma. Drainage procedures, such as the Partington-Rochelle method, are used in patients with isolated congestion of the pancreatic duct without further organ complications, such as inflammatory processes of the pancreatic head; however, patients with CP often have an inflammatory swelling of the pancreatic head. In this case classical pancreatoduodenectomy (PD) or organ-sparing duodenum-preserving pancreatic head resection (DPPHR) with its various techniques (e.g. Beger, Frey, Bern and V‑shape) can be applied. Due to similar long-term results PD should be carried out in cases of suspicion or detection of malignancies and DPPHR for treatment of CP.

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Literatur

  1. Majumder S, Chari ST (2016) Chronic pancreatitis. Lancet 387:1957–1966

    Article  PubMed  Google Scholar 

  2. Pasricha PJ (2012) Unraveling the mystery of pain in chronic pancreatitis. Nat Rev Gastroenterol Hepatol 9:140–151

    Article  CAS  PubMed  Google Scholar 

  3. Dufour MC, Adamson MD (2003) The epidemiology of alcohol-induced pancreatitis. Pancreas 27:286–290

    Article  PubMed  Google Scholar 

  4. Lowenfels AB, Maisonneuve P, Cavallini G et al (1994) Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol 89:1467–1471

    CAS  PubMed  Google Scholar 

  5. Fasanella KE, Davis B, Lyons J et al (2007) Pain in chronic pancreatitis and pancreatic cancer. Gastroenterol Clin North Am 36(ix):335–364

    Article  PubMed  Google Scholar 

  6. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R (2010) Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol 24:349–358

    Article  PubMed  Google Scholar 

  7. German Society of Digestive and Metabolic Diseases, Hoffmeister A et al (2012) Chronic Pancreatitis: S3-Consensus guidelines on definition, etiology, diagnosis and medical, endoscopic and surgical management of chronic pancreatitis German Society of Digestive and Metabolic Diseases (DGVS). Z Gastroenterol 50:1176–1224

    Article  Google Scholar 

  8. Partington PF, Rochelle RE (1960) Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 152:1037–1043

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bradley EL 3rd (1987) Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg 153:207–213

    Article  PubMed  Google Scholar 

  10. Buchler MW, Warshaw AL (2008) Resection versus drainage in treatment of chronic pancreatitis. Gastroenterology 134:1605–1607

    Article  PubMed  Google Scholar 

  11. Beger HG, Witte C, Krautzberger W, Bittner R (1980) Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg 51:303–307

    CAS  PubMed  Google Scholar 

  12. Frey CF, Smith GJ (1987) Description and rationale of a new operation for chronic pancreatitis. Pancreas 2:701–707

    Article  CAS  PubMed  Google Scholar 

  13. Gloor B, Friess H, Uhl W, Buchler MW (2001) A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 18:21–25

    Article  CAS  PubMed  Google Scholar 

  14. Saeger HD, Schwall G, Trede M (1995) The Whipple partial duodenopancreatectomy – its value in the treatment of chronic pancreatitis. Zentralbl Chir 120:287–291

    CAS  PubMed  Google Scholar 

  15. Frey CF, Child CG, Fry W (1976) Pancreatectomy for chronic pancreatitis. Ann Surg 184:403–413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Izbicki JR, Bloechle C, Broering DC, Kuechler T, Broelsch CE (1998) Longitudinal V‑shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure. Ann Surg 227:213–219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bockhorn M, Gebauer F, Bogoevski D et al (2011) Chronic pancreatitis complicated by cavernous transformation of the portal vein: contraindication to surgery? Surgery 149:321–328

    Article  PubMed  Google Scholar 

  18. Cahen DL, Gouma DJ, Laramee P et al (2011) Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 141:1690–1695

    Article  PubMed  Google Scholar 

  19. Dite P, Ruzicka M, Zboril V, Novotny I (2003) A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 35:553–558

    Article  CAS  PubMed  Google Scholar 

  20. Klempa I, Spatny M, Menzel J et al (1995) Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple’s operation. Chirurg 66:350–359

    CAS  PubMed  Google Scholar 

  21. Buchler MW, Friess H, Muller MW, Wheatley AM, Beger HG (1995) Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 169:65–70

    Article  CAS  PubMed  Google Scholar 

  22. Muller MW, Friess H, Martin DJ, Hinz U, Dahmen R, Buchler MW (2008) Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg 95:350–356

    Article  CAS  PubMed  Google Scholar 

  23. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE (1995) Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial. Ann Surg 221:350–358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bachmann K, Tomkoetter L, Erbes J et al (2014) Beger and Frey procedures for treatment of chronic pancreatitis: comparison of outcomes at 16-year follow-up. J Am Coll Surg 219:208–216

    Article  PubMed  Google Scholar 

  25. Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE (1998) Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg 228:771–779

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Strate T, Bachmann K, Busch P et al (2008) Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 134:1406–1411

    Article  PubMed  Google Scholar 

  27. Koninger J, Seiler CM, Sauerland S et al (2008) Duodenum-preserving pancreatic head resection – a randomized controlled trial comparing the original Beger procedure with the Berne modification (ISRCTN No. 50638764). Surgery 143:490–498

    Article  PubMed  Google Scholar 

  28. Klaiber U, Alldinger I, Probst P et al (2016) Duodenum-preserving pancreatic head resection: 10-year follow-up of a randomized controlled trial comparing the Beger procedure with the Berne modification. Surgery 160:127–135

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Deutschland

    E. Bellon, J. R. Izbicki &  M. Bockhorn

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  1. E. Bellon
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  2. J. R. Izbicki
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  3. M. Bockhorn
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Correspondence to M. Bockhorn.

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Interessenkonflikt

E. Bellon, J.R. Izbicki und M. Bockhorn geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bellon, E., Izbicki, J.R. & Bockhorn, M. Pankreasanastomosen bei operativer Versorgung der chronischen Pankreatitis. Chirurg 88, 18–24 (2017). https://doi.org/10.1007/s00104-016-0303-1

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