[Choice of surgical procedure in operations for chronic pancreatitis--personal experience].
The First Surgical Clinic of the First Medical Faculty of Charles University and General Faculty Hospital in Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum-sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional case MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 21 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was preformed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 123 patients a drainage and duodenum sparing operation was preformed, of these in 57 according to Beger, 19 according to Frey, 37 Partington-Rochelle's procedure. The authors record two sepsis postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patients co-operation round 84-87% while authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the deteriation of the compartment syndrome in the left half of the gland. Its result is destruction of the remainder of exocrine and endocrine tissue. Of 187 operated patients one patient with decompensated diabetes died postoperatively. Based on their own experience the authors do not consider repeated re-operations an absolute contraindication of Beger's operation when conditions permit. A problem is, in their opinion, fibrosis in the vicinity of the pancreas and portal overpressure.
Sváb
J
J
I. chirurgická klinika 1. lékarské fakulty Univerzity Karlovy a Vseobecné fakultní nemocnice v Praze, U nemocnice 2, 128 08 Praha 2, Czech Republic. jan.svab@lf1.cuni.cz
Pesková
M
M
Fried
M
M
Gürlich
R
R
Krska
Z
Z
Bortlík
M
M
Lukás
M
M
Horejs
J
J
D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000601:surgery*; D011183:Postoperative Complications
Který chirurgický výkon volit v operacní lécbĕ chronického zánĕtu slinivky brisní--nase zkusenosti.