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World Journal of Surgery Apr 2018Limited pancreatic resections are increasingly performed, but the rate of postoperative fistula is higher than after classical resections. Pancreatic segmentation,... (Review)
Review
BACKGROUND
Limited pancreatic resections are increasingly performed, but the rate of postoperative fistula is higher than after classical resections. Pancreatic segmentation, anatomically and radiologically identifiable, may theoretically help the surgeon removing selected anatomical portions with their own segmental pancreatic duct and thus might decrease the postoperative fistula rate. We aimed at systematically and comprehensively reviewing the previously proposed pancreatic segmentations and discuss their relevance and limitations.
METHODS
PubMed database was searched for articles investigating pancreatic segmentation, including human or animal anatomy, and cadaveric or surgical studies.
RESULTS
Overall, 47/99 articles were selected and grouped into 4 main hypotheses of pancreatic segmentation methodology: anatomic, vascular, embryologic and lymphatic. The head, body and tail segments are gross description without distinct borders. The arterial territories defined vascular segments and isolate an isthmic paucivascular area. The embryological theory relied on the fusion plans of the embryological buds. The lymphatic drainage pathways defined the lymphatic segmentation. These theories had differences, but converged toward separating the head and body/tail parts, and the anterior from posterior and inferior parts of the pancreatic head. The rate of postoperative fistula was not decreased when surgical resection was performed following any of these segmentation theories; hence, none of them appeared relevant enough to guide pancreatic transections.
CONCLUSION
Current pancreatic segmentation theories do not enable defining anatomical-surgical pancreatic segments. Other approaches should be explored, in particular focusing on pancreatic ducts, through pancreatic ducts reconstructions and embryologic 3D modelization.
Topics: Animals; Drainage; Female; Fistula; Humans; Imaging, Three-Dimensional; Lymph Nodes; Male; Pancreas; Pancreatectomy; Pancreatic Ducts; Postoperative Complications; Surgical Procedures, Operative
PubMed: 28975436
DOI: 10.1007/s00268-017-4263-5 -
Journal of Visualized Experiments : JoVE May 2012This dissection and sampling procedure was developed for the Network for Pancreatic Organ Donors with Diabetes (nPOD) program to standardize preparation of pancreas...
This dissection and sampling procedure was developed for the Network for Pancreatic Organ Donors with Diabetes (nPOD) program to standardize preparation of pancreas recovered from cadaveric organ donors. The pancreas is divided into 3 main regions (head, body, tail) followed by serial transverse sections throughout the medial to lateral axis. Alternating sections are used for fixed paraffin and fresh frozen blocks and remnant samples are minced for snap frozen sample preparations, either with or without RNAse inhibitors, for DNA, RNA, or protein isolation. The overall goal of the pancreas dissection procedure is to sample the entire pancreas while maintaining anatomical orientation. Endocrine cell heterogeneity in terms of islet composition, size, and numbers is reported for human islets compared to rodent islets. The majority of human islets from the pancreas head, body and tail regions are composed of insulin-containing β-cells followed by lower proportions of glucagon-containing α-cells and somatostatin-containing δ-cells. Pancreatic polypeptide-containing PP cells and ghrelin-containing epsilon cells are also present but in small numbers. In contrast, the uncinate region contains islets that are primarily composed of pancreatic polypeptide-containing PP cells. These regional islet variations arise from developmental differences. The pancreas develops from the ventral and dorsal pancreatic buds in the foregut and after rotation of the stomach and duodenum, the ventral lobe moves and fuses with the dorsal. The ventral lobe forms the posterior portion of the head including the uncinate process while the dorsal lobe gives rise to the rest of the organ. Regional pancreatic variation is also reported with the tail region having higher islet density compared to other regions and the dorsal lobe-derived components undergoing selective atrophy in type 1 diabetes. Additional organs and tissues are often recovered from the organ donors and include pancreatic lymph nodes, spleen and non-pancreatic lymph nodes. These samples are recovered with similar formats as for the pancreas with the addition of isolation of cryopreserved cells. When the proximal duodenum is included with the pancreas, duodenal mucosa may be collected for paraffin and frozen blocks and minced snap frozen preparations.
Topics: Dissection; Humans; Organ Preservation; Pancreas; Tissue and Organ Harvesting
PubMed: 22665046
DOI: 10.3791/4039 -
Ugeskrift For Laeger Jun 2020
Topics: Humans; Pancreas
PubMed: 32584761
DOI: No ID Found -
International Journal of Pancreatology... Sep 1989
Review
Topics: Animals; Pancreas; Sympathetic Nervous System
PubMed: 2689524
DOI: 10.1007/BF02924411 -
Klinicheskaia Meditsina Feb 1980
Review
Topics: Animals; Digestion; Digestive System; Digestive System Physiological Phenomena; Duodenum; Gastric Juice; Humans; Intestinal Secretions; Islets of Langerhans; Liver; Pancreas; Stomach
PubMed: 6988640
DOI: No ID Found -
Nature Genetics Sep 2002
Topics: Animals; Mice; Pancreas; Transcription Factors
PubMed: 12205472
DOI: 10.1038/ng0902-85 -
Journal of the Indian Medical... Mar 1967
Topics: Adult; Female; Humans; Pancreas
PubMed: 6038535
DOI: No ID Found -
Journal of Gastroenterology and... Sep 2006The pancreas is a retroperitoneal organ and has been classically considered to be immobile on respiration. Recent radiological studies assessing the mobility of the...
BACKGROUND AND AIM
The pancreas is a retroperitoneal organ and has been classically considered to be immobile on respiration. Recent radiological studies assessing the mobility of the pancreas have challenged this traditional concept. The present study was conducted to assess the movement of pancreas with respiration using fluoroscopy, a simple and inexpensive method.
METHODS
Patients with chronic pancreatitis who had either pancreatic calcification evident on fluoroscopy or an indwelling pancreatic duct stent were studied. The movement of the pancreas was assessed under fluoroscopy by measuring the displacement of the stent or calcification in relationship to the spine in maximum inspiration followed by maximum expiration.
RESULTS
Twenty-two patients (mean age 35.45 + or - 11.29 years, 17 men) with chronic pancreatitis were included in the study. Ten patients had pancreatic calcification and 12 had an indwelling pancreatic duct stent (two in the dorsal duct, 10 in the ventral duct). In all patients, the pancreas moved downward in the craniocaudal direction on deep inspiration. Pancreatic excursion from maximum inspiration to maximum expiration ranged from 0.1 to 3.4 cm. In addition, a medial movement of the head of pancreas was also noted in most of the patients. On univariate analysis, no association was found between the range of movement and the age or sex of the patient, duration or etiology of disease, presence or absence of calcification, severity of ductal changes of chronic pancreatitis and the length or diameter of the pancreatic stent placed.
CONCLUSION
The pancreas moves craniocaudally with respiration and the head moves medially on inspiration.
Topics: Adult; Calcinosis; Female; Fluoroscopy; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Respiration; Stents
PubMed: 16911687
DOI: 10.1111/j.1440-1746.2006.04324.x -
Medicina Clinica May 2023Pancreatic trauma is a rare but potentially lethal entity which requires a high level of clinical suspicion. Early diagnosis and assessment of the integrity of the... (Review)
Review
Pancreatic trauma is a rare but potentially lethal entity which requires a high level of clinical suspicion. Early diagnosis and assessment of the integrity of the pancreatic duct are essential since ductal injury is a crucial predictor of morbimortality. Overall mortality is 19%, which can rise to 30% in cases of ductal injury. The diagnostic and therapeutic approach is multidisciplinary and guided by a surgeon, imaging specialist and ICU physician. Laboratory analysis shows that pancreatic enzymes are frequently elevated, which is a low specificity finding. In hemodynamically stable patients, the posttraumatic condition of the pancreas is firstly evaluated by the multidetector computed tomography. Moreover, in case of suspicion of ductal injury, more sensitive studies such as Endoscopic Retrograde Cholangiopancreatography or cholangioresonance are needed. This narrative review aims to analyze the etiopathogenesis and pathophysiology of pancreatic trauma and discuss its diagnosis and treatment. Also, the most clinically relevant complications will be summarized.
Topics: Humans; Pancreas; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Ducts; Pancreatic Diseases; Abdominal Injuries
PubMed: 37005125
DOI: 10.1016/j.medcli.2023.03.002 -
Surgery Jun 2002
Topics: Adolescent; Adult; Anastomosis, Surgical; Child; Endoscopy; Female; Humans; Pancreas; Postoperative Period; Radiography; Wounds, Nonpenetrating
PubMed: 12075189
DOI: 10.1067/msy.2002.123009