title: Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy.
abstract: BACKGROUND
  The term "paraduodenal pancreatitis" (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly.
  
  
  OBJECTIVE
  To assess the results of different types of treatment for PP.
  
  
  METHODS
  Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded.
  
  
  RESULTS
  Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD.
  
  
  CONCLUSIONS
  PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.
authors.affiliation: Department of Surgical Oncology, Moscow City Hospital No. 5, Sechenov First Moscow State Medical University, Stromynka Street 7, Moscow 107076, Russia.
authors.forename: V I
authors.initials: VI
authors.lastname: Egorov
authors.affiliation: Hepatopancreatobiliary Department, Vishnevsky Institute of Surgery, Bolshaya Serpukhovskaya Street 27, Moscow 117997, Russia.
authors.forename: A N
authors.initials: AN
authors.lastname: Vankovich
authors.affiliation: Department of Surgical Oncology, Moscow City Hospital No. 5, Sechenov First Moscow State Medical University, Stromynka Street 7, Moscow 107076, Russia.
authors.forename: R V
authors.initials: RV
authors.lastname: Petrov
authors.affiliation: Department of Surgical Oncology, Moscow City Hospital No. 5, Sechenov First Moscow State Medical University, Stromynka Street 7, Moscow 107076, Russia.
authors.forename: N S
authors.initials: NS
authors.lastname: Starostina
authors.affiliation: General Surgery Department, Central Hospital of FSS RF, Petrovskoye Schosse 48, Golitsino, Moscow 143040, Russia.
authors.forename: A Ts
authors.initials: ATs
authors.lastname: Butkevich
authors.affiliation: General Surgery Department, Moscow City Hospital No. 4, N. Pirogov Russian National Research Medical University, Ostrovityanova Street 1, Moscow 117513, Russia.
authors.forename: A V
authors.initials: AV
authors.lastname: Sazhin
authors.affiliation: Department of Pathology, Moscow City Hospital No. 12, Bakinskaya Street 26, Moscow 115516, Russia.
authors.forename: E A
authors.initials: EA
authors.lastname: Stepanova
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000473:pathology; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000473:pathology; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography