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Surgical and Radiologic Anatomy : SRA Sep 2022Anatomical variations of the pancreas are relatively frequent and often understudied. The ductal system of the pancreas has multiple variations, which are not frequently...
PURPOSE
Anatomical variations of the pancreas are relatively frequent and often understudied. The ductal system of the pancreas has multiple variations, which are not frequently reported in the literature.
MATERIALS AND METHODS
The anatomy of the pancreas was studied through macroscopic anatomical dissection on 50 organ complexes (the pancreas, spleen, and duodenum) donated to the department of human anatomy, from patients, who died of causes not related to pancreatic diseases.
RESULTS
In type I, the main pancreatic duct (Wirsung's duct, MPD) and the accessory pancreatic duct (Santorini's duct, APD) were merged but most of the head was drained by the MPD (10% of cases). In type II, the MPD and APD were merged but most of the head was drained by the APD (4% of cases). In type III, the APD was absent and the head was drained by the MPD (14% of cases). In type IV, there was an inverted pancreas divisum where the ducts did not merge but each drained a part of the head (6% of cases). Classical pancreas divisum where the ducts did not merge but each drained a part of the head was considered as type V (4% of cases). In type VI, the MPD and APD merged and each drained a part of the head (48% of cases). In type VII, the MPD and APD merged but the upper part of the head was drained by the main pancreatic duct (4% of cases). In type VIII, the MPD and APD merged but the lower part of the head was drained by the main pancreatic duct (4% of cases). In the IX type, the MPD and APD merged but the head was drained by the branches of the MPD (6% of cases).
CONCLUSIONS
There are several drainage patterns of the pancreas. In some cases, one of the ducts provides more drainage of the gland than the other. This is clinically relevant since blockage of the main source of drainage leads to pancreatic juice stasis. It also explains cases when partial or total blockage of the duct results in the pancreatitis of an isolated zone.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis
PubMed: 35986117
DOI: 10.1007/s00276-022-03002-w -
HPB : the Official Journal of the... Sep 2022Pancreatoduodenectomy is burdened by elevated postoperative morbidity. Pancreatic duct ligation or occlusion have been experimented as an alternative to reduce the... (Meta-Analysis)
Meta-Analysis Review
Postoperative morbidity and mortality after pancreatoduodenectomy with pancreatic duct occlusion compared to pancreatic anastomosis: a systematic review and meta-analysis.
BACKGROUND
Pancreatoduodenectomy is burdened by elevated postoperative morbidity. Pancreatic duct ligation or occlusion have been experimented as an alternative to reduce the insurgence of postoperative pancreatic fistula. The aim of this systematic review and meta-analysis was to compare postoperative mortality and morbidity (pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, pancreatic exocrine insufficiency and diabetes mellitus) between patients undergoing pancreatic anastomosis or pancreatic duct ligation/occlusion after pancreatoduodenectomy.
METHODS
A systematic review and meta-analysis of 13 studies was conducted following the PRISMA guidelines and the Cochrane protocol (PROSPERO ID: CRD42021249232).
RESULTS
No difference in postoperative mortality was highlighted. Pancreatic anastomosis was found to be protective considering all-grades pancreatic fistula (RR: 2.38, p = 0.0005), but pancreatic duct occlusion presented a 3-folded reduced risk to develop "grade C" pancreatic fistula (RR: 0.36, p = 0.1186), although not significant. Diabetes mellitus was more often diagnosed after duct occlusion (RR: 1.61, p < 0.0001); no difference was found in terms of pancreatic exocrine insufficiency (RR: 1.19, p = 0.151).
CONCLUSION
Postoperative mortality is not influenced by the pancreatic reconstruction technique. Pancreatic anastomosis is associated with a reduction in all-grades pancreatic fistula. More high-quality studies are needed to clarify if duct sealing could reduce the prevalence of "grade C" fistula.
Topics: Anastomosis, Surgical; Exocrine Pancreatic Insufficiency; Humans; Morbidity; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications
PubMed: 35450800
DOI: 10.1016/j.hpb.2022.03.015 -
Khirurgiia 2022To evaluate the efficacy of endoscopic retrograde stenting of the pancreatic duct for acute severe pancreatitis.
OBJECTIVE
To evaluate the efficacy of endoscopic retrograde stenting of the pancreatic duct for acute severe pancreatitis.
MATERIAL AND METHODS
We analyzed 94 patients with acute severe pancreatitis who underwent surgery (=87, 92.6%) and endoscopic retrograde pancreatic stenting (=28, 29.8%). The first group included 15 patients (16%) after pancreatic duct stenting in aseptic phase of acute pancreatitis. The second group enrolled 13 patients (13.8%) who underwent pancreatic duct stenting in the phase of sequestration and infection. The third group consisted of 66 patients (70.2%) after open surgery without pancreatic duct stenting.
RESULTS
In the 1 group, we recanalized the necrosis zone up to distal pancreas via stenting. Infection was detected in 14 out of 15 patients. Surgical treatment was performed in 13 patients (13.8%). In the second group, pancreatic duct stenting was carried out in the phase of infected pancreatitis. We applied stenting to block the area of duct destruction or restore outflow in case of distal defect. No infection was observed in 1 out of 13 patients. Pancreatic duct stenting was not performed in 66 patients of the third group. Surgical treatment was performed in 59 patients (62.8%). In general, 11 of 94 patients (11.7%) were free from infection.
CONCLUSION
Better postoperative outcomes were observed in patients with damage to pancreatic duct, pancreatic drainage through percutaneous drains installed at the first stage of treatment. Early pancreatic duct stenting did not lead to significant improvement in treatment outcomes.
Topics: Acute Disease; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Humans; Pancreas; Pancreatic Ducts; Pancreatitis; Stents; Treatment Outcome
PubMed: 35658132
DOI: 10.17116/hirurgia202206118 -
Medicine Aug 2023Laparoscopic pancreaticoduodenectomy (LPD) is a classic surgical method for diseases, such as tumors at the lower end of the common bile duct, pancreatic head, and...
Laparoscopic pancreaticoduodenectomy (LPD) is a classic surgical method for diseases, such as tumors at the lower end of the common bile duct, pancreatic head, and benign and malignant tumors of the duodenum. Postoperative pancreatic fistula (POPF) is one of the most serious complications of LPD. To reduce the incidence of grade B or C POPF and other complications after LPD, we applied a split pancreatic duct stent combined with the characteristics of internal and external stent drainage. Between September 2020 and September 2022,12 patients underwent placement of the Split pancreatic duct stent during LPD. Data on basic characteristics of patients, surgical related indicators and postoperative POPF incidence were collected and analyzed. The results showed that the average operation time was 294.2 ± 36 minutes, average time for pancreaticojejunostomy was 35.9 ± 4.1 minutes, and average estimated blood loss was 204.2 ± 58.2 mL. Biochemical leakage occurred in 2 patients (16.7%), whereas no grade B or C POPF, 1 case (8.3%) had postoperative bleeding, and no death occurred within 30 days after the operation. Preliminary experience shows that the split pancreatic duct stent can effectively reduce the incidence of complications after LPD, especially grade B or C POPF.
Topics: Humans; Pancreaticoduodenectomy; Pancreatic Ducts; Pancreas; Pancreaticojejunostomy; Pancreatic Fistula; Postoperative Complications; Laparoscopy; Stents; Retrospective Studies
PubMed: 37543786
DOI: 10.1097/MD.0000000000034049 -
Gastrointestinal Endoscopy Clinics of... Jul 2024Pancreatic duct (PD) leaks are a common complication of acute and chronic pancreatitis, trauma to the pancreas, and pancreatic surgery. Diagnosis of PD leaks and... (Review)
Review
Pancreatic duct (PD) leaks are a common complication of acute and chronic pancreatitis, trauma to the pancreas, and pancreatic surgery. Diagnosis of PD leaks and fistulas is often made with contrast-enhanced pancreatic protocol computed tomography or magnetic resonance imaging with MRCP. Endoscopic retrograde pancreatography with pancreatic duct stenting in appropriately selected patients is often an effective treatment, helps to avoid surgery, and is considered first-line therapy in cases that fail conservative management.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Fistula; Pancreatic Ducts; Stents; Pancreatitis; Tomography, X-Ray Computed; Postoperative Complications
PubMed: 38796289
DOI: 10.1016/j.giec.2024.02.001 -
Digestive Diseases and Sciences Feb 2024Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous... (Review)
Review
Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous drains or external wound (following surgery) due to the communication of the peripancreatic collection with the main pancreatic duct (MPD). Internal pancreatic fistulas include communication of the pancreatic duct (directly or via intervening collection) with the pleura, pericardium, mediastinum, peritoneal cavity, or gastrointestinal tract. Cross-sectional imaging plays an essential role in the management of pancreatic fistulas. With the help of multiplanar imaging, fistulous tracts can be delineated clearly. Thin computed tomography sections and magnetic resonance cholangiopancreatography images may demonstrate the communication between MPD and pancreatic fluid collections or body cavities. Endoscopic retrograde cholangiography (ERCP) is diagnostic as well as therapeutic. In this review, we discuss the imaging diagnosis and management of various types of pancreatic fistulas with the aim to sensitize radiologists to timely diagnosis of this critical complication of pancreatitis.
Topics: Humans; Pancreatic Fistula; Cholangiopancreatography, Endoscopic Retrograde; Pancreatitis; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Magnetic Resonance Imaging
PubMed: 38114791
DOI: 10.1007/s10620-023-08173-z -
Abdominal Radiology (New York) Feb 2021Wirsungocele is a rare cystic dilatation of the main pancreatic duct seen at the terminal portion of the duct of Wirsung. The purpose of our study is to evaluate the...
PURPOSE
Wirsungocele is a rare cystic dilatation of the main pancreatic duct seen at the terminal portion of the duct of Wirsung. The purpose of our study is to evaluate the diagnostic value of MRCP in detection of Wirsungocele and the association between the MRCP-determined size of Wirsungocele and the MRCP-clinical findings of pancreatitis.
METHODS
Thirty-four patients with reported 'Wirsungocele' were analyzed in the study. Two radiologists reviewed MRCP/S-MRCP images for the presence and diameter of Wirsungocele (WD), main pancreatic duct dilatation (MPDD), side branch ectasia (SBE), acinarization, and duodenal filling grade. Electronic medical record review included symptoms (abdominal pain), signs (recurrent acute/chronic pancreatitis), and select laboratory testing (serum amylase and lipase). Inter-reader agreement values were calculated by ICC. Pearson correlation analysis was performed to evaluate the association of WD with radiological and clinical findings. The comparison of WD on MRCP versus S-MRCP was calculated by Wilcoxon test. Mann-Whitney U test was used for two independent variable comparisons.
RESULTS
The sensitivity of MRCP for the detection of Wirsungocele calculated using the S-MRCP and ERCP as the reference method was 76.9% and 100%, respectively. There was a significant difference in the diameter of Wirsungocele measured by MRCP vs S-MRCP (p < 0.001). There was good inter-reader agreement for the detection of Wirsungocele on MRCP and measurement of WD on MRCP and S-MRCP (ICC: 0.79, 0.89, and 0.80, respectively, p < 0.001). There was a significant difference in WD between the patients with and without MPDD (p < 0.05). There was a significant positive correlation between WD and MPDD (r = 0.66, p < 0.05). WD was significantly associated with recurrent acute pancreatitis (p < 0.05).
CONCLUSION
MRCP is a highly sensitive and non-invasive imaging tool for detection of Wirsungocele. Greater Wirsungocele diameter is associated with MPDD and recurrent acute pancreatitis.
Topics: Acute Disease; Cholangiopancreatography, Magnetic Resonance; Humans; Pancreatic Ducts; Pancreatitis, Chronic
PubMed: 32737547
DOI: 10.1007/s00261-020-02675-4 -
ANZ Journal of Surgery May 2024Pancreatic cancer recurrence following surgery is a significant challenge, and personalized surgical care is crucial. Topographical variations in pancreatic duct anatomy...
INTRODUCTION
Pancreatic cancer recurrence following surgery is a significant challenge, and personalized surgical care is crucial. Topographical variations in pancreatic duct anatomy are frequent but often underestimated. This study aimed to investigate the potential importance of these variations in outcomes and patient survival after Whipple's procedures.
METHODS
Data were collected from 105 patients with confirmed pancreatic head neoplasms who underwent surgery between 2008 and 2020. Radiological measurements of pancreatic duct location were performed, and statistical analysis was carried out using IBM SPSS.
RESULTS
Inferior pancreatic duct topography was associated with an increased rate of metastatic spread and tumour recurrence. Additionally, inferior duct topography was associated with reduced overall and recurrence-free survival. Posterior pancreatic duct topography was associated with decreased incidence of perineural sheet infiltration and improved overall survival.
DISCUSSION
These findings suggest that topographical diversity of pancreatic duct location can impact outcomes in Whipple's procedures. Intraoperative review of pancreatic duct location could help surgeons define areas of risk or safety and deliver a personalized surgical approach for patients with beneficial or deleterious anatomical profiles. This study provides valuable information to improve surgical management by identifying high-risk patients and delivering a personalized surgical approach with prognosis stratification.
Topics: Humans; Pancreatic Neoplasms; Male; Female; Pancreatic Ducts; Aged; Middle Aged; Pancreaticoduodenectomy; Retrospective Studies; Neoplasm Recurrence, Local; Treatment Outcome; Prognosis
PubMed: 38426386
DOI: 10.1111/ans.18903 -
Georgian Medical News Apr 2022The main purpose of this study was to conduct retrospective clinical analysis of patients with malignant tumor of the periampullary zone who underwent Whipple procedure...
The main purpose of this study was to conduct retrospective clinical analysis of patients with malignant tumor of the periampullary zone who underwent Whipple procedure surgery depending on the pancreatic thickness and pancreatic duct diameter and to assess the development of pancreatic fistulas in the postoperative period. A retrospective review was performed to 108 patients with resectable periampular zone tumors. All patients were divided into two groups depending on the pancreatic thickness, 58 (53.7%) patients in soft thickness, 50 (46.3%) patients in hard thickness. In two groups, pancreatic fistulas were observed in 27 (25.0%) patients, where the majority of cases occurred with soft gland in 20 (18.6%) patients than with hard gland in 7 (6.4%) patients. Thus, the efficiency of pancreatojunoanastomosis formation depends on the pancreatic thickness and the pancreatic duct diameter. Pancreatic fistula after pancreatoduodenal resection was more observed with soft gland than with hard gland, and with a pancreatic duct diameter of more than 3.0 mm, pancreatic fistula developed 2 times less than with a diameter of less than 3.0 mm.
Topics: Humans; Pancreas; Pancreatic Ducts; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies
PubMed: 35920575
DOI: No ID Found -
Nagoya Journal of Medical Science Nov 2023Endoscopic papillectomy is widely performed to treat duodenal papillary tumors, particularly at high-volume centers. It is indicated for adenomas without intraductal... (Review)
Review
Endoscopic papillectomy is widely performed to treat duodenal papillary tumors, particularly at high-volume centers. It is indicated for adenomas without intraductal extension of the bile or pancreatic ducts. However, despite numerous reports of carcinomas that expand the indications to include well-differentiated adenocarcinomas that do not invade the sphincter of Oddi, the low agreement between biopsy and final pathological diagnosis, as well as the current inability of imaging modalities to diagnose sphincter of Oddi invasion, makes it difficult to consider expanding indications. Although complications can be prevented by certain methods, such as pancreatic duct stenting, and the frequency of severe complications has decreased, the safety of the procedure remains unconfirmed. In the future, this technology is expected to progress and enable wider applications, including those in tumors with extensive horizontal spread and those with intraductal extension of the bile and pancreatic ducts. Such technology may also improve the safety and accuracy of diagnosis.
Topics: Humans; Ampulla of Vater; Endoscopy; Pancreatic Ducts; Biopsy; Adenocarcinoma; Treatment Outcome
PubMed: 38155621
DOI: 10.18999/nagjms.85.4.648