Pancreas Divisum: a Differentiated Surgical Approach in Symptomatic Patients

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2011 Apr 8

PMID 21472371

Citations 4

Authors

Lutz Schneider

Elias Muller

Ulf Hinz

Lars Grenacher

Markus W Buchler

Jens Werner

Affiliations

Soon will be listed here.

Abstract

Background: Some patients with pancreas divisum (PD) develop symptoms of recurrent pancreatitis. This is probably caused by insufficient drainage of the pancreatic duct. We report the results of our follow-up of patients who underwent surgery for symptomatic pancreas divisum according to an individualized surgical approach.

Methods: Between October 2001 and April 2009, 28 patients with symptomatic pancreas divisum were operated at the University Hospital of Heidelberg. According to the localization and type of morphological changes of the pancreas, patients received a reinsertion of the papilla (SP; n=11), duodenum-preserving pancreatic head resection (DPPHR; n=10), pylorus-preserving Whipple (ppWhipple; n=4), or other pancreatic resections (n=3). Hospitalization, morbidity, mortality, pain course, and patient satisfaction were analyzed.

Results: Before surgery, patients received a median of three endoscopic interventions and were hospitalized for 77 days. The median postoperative follow-up was 4.1 years. Surgical morbidity was 11% and mortality 0%. We performed an SP when the pancreas was soft (n=10). When the pancreas was inflammatory altered, a DPPHR was performed in ten, ppW in four, segmental resection in two, and SP and pancreatic left resection in one case. A redo operation for persisting symptoms was needed in six patients (3 soft and 3 altered pancreas). Compared with the preoperative situation, pain was significantly reduced in the follow-up (median Visual Analogue Scale 0 vs. 10). Ninety-six percent of patients were without symptoms during the follow-up.

Conclusions: The individualized surgical approach for patients with symptomatic PD achieves significant reduction of pain in all patients. Reinsertions of the papilla should be performed as a first surgical intervention in patients with a soft pancreas when symptoms persist despite adequate endoscopic treatment. DPPHR should be performed when fibrotic alterations of the pancreas are present.

Citing Articles

Indications and outcomes of duodenum-preserving resection of the pancreatic head in children.

Snajdauf J, Rygl M, Petru O, Nahlovsky J, Frybova B, Durilova M Pediatr Surg Int. 2018; 35(4):449-455.

PMID: 30386905 DOI: 10.1007/s00383-018-4410-6.

Pancreas divisum: correlation between anatomical abnormalities and bile precipitation in the gallbladder in seven patients.

Izzo P, Di Cello P, Pugliese F, Izzo S, Grande R, Biancucci F G Chir. 2016; 37(4):155-157.

PMID: 27938531 PMC: 5161217. DOI: 10.11138/gchir/2016.37.4.155.

Surgical ampullectomy: an underestimated operation in the era of endoscopy.

Schneider L, Contin P, Fritz S, Strobel O, Buchler M, Hackert T HPB (Oxford). 2016; 18(1):65-71.

PMID: 26776853 PMC: 4750227. DOI: 10.1016/j.hpb.2015.07.004.

Selective agenesis of pancreatic isthmus parenchyma with preservation of main pancreatic duct continuity, a very rare entity: Case report.

Paiella S, De Pastena M, Esposito A, Salvia R, Morigi C, Bassi C Int J Surg Case Rep. 2014; 6C:169-71.

PMID: 25544484 PMC: 4347963. DOI: 10.1016/j.ijscr.2014.09.023.

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