Background: Intractable pain is the most distressing symptom in patients suffering from unresectable pancreatic carcinoma and chronic pancreatitis and thoracoscopic splanchnicectomy is an emerging method in the past decade for pain control. Objectives: To evaluate the effectiveness and safety of thoracoscopic splanchnicectomy in controlling pain due to pancreatic diseases. Subjects and method: This descriptive, cross-sectional study was carried out between May 2004 and August 2006, on 29 patients with unresectable pancreatic carcinoma and chronic pancreatitis, treated by thoracoscopic splanchnicectomy. Their subjective pain was assessed by visual analogue scale (VAS). Intra- and post- operative complications and mortality, operative time and hospital length also so have been evaluated. Results: Among 29 patients, there were 21 cases of pancreatic carcinoma (11 males and 10 females) and 8 cases of chronic pancreatitis (100% were male). The average operative time was 133.27 \xb1 8.32 min (range 90-270 min). 27 cases (93.1%) underwent bilateral thoracoscopic splanchnicectomy and 2 cases (6.9%) underwent unilateral procedure. There was no death due to procedure. The mean hospital stay was 4.86 \xb1 0.56 days (range, 1\ufffd?3 days). Pain relief was most effective in the 1st week after operations. Conclusion: Thoracoscopic splanchnicectomy is a safe and effective procedure of treating malignant and benign intractable pancreatic pain. It is needed to study long-term efficacy of pain relief for chronic pancreatitis.
Pancreatic Diseases/ surgery ; Thoracoscopy ;

Enhanced recovery after surgery is a multimodal perioperative strategy according to the evidence-based medicine and multidisciplinary collaboration, aiming to improve the restoration of functional capacity after surgery by reducing surgical stress, optimal control of pain, early oral diet and early mobilization. Compared with other sub-specialty in general surgery, pancreatic surgery is characterized by complex disease, highly difficult procedure and more postoperative complications. Accordingly, pancreatic surgery shares a slow development in enhanced recovery after surgery. In this review, the feasibility, safety, application progress, prospect and controversy of enhanced recovery after surgery in pancreatic surgery are discussed.
Humans ; Pancreas ; surgery ; Pancreatic Diseases ; surgery ; Postoperative Complications ; prevention & control

Abscess ; surgery ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pancreatic Diseases ; surgery

A retrospective survey was conducted on 62 patients aged 20-70 years during the period from 1995-1997 with a gender ratio of 64.5%/34.5% (male/female). Subjects were diagnosed as bile duct occlusion icteria due to the tumors of pancreatic head. Not any surgical interventions were performed. Main clinical signs were progressive jaundice, no fever, weigh loss, white faeces, and large size of liver and pancreas. Hematological exams and imaging diagnosis including ultrasonography were carried out. Survival times of an average of 2.8 months for operable group and under 1 month for non operable group were noted
Bile Ducts ; Peptic Ulcer ; Pancreatic Diseases ; neoplasms ; surgery

Digital medicine has gone through more than 20 years in China.Digital intelligent technologies such as three-dimensional(3D) visualization, virtual reality, augmented reality and mixed reality have been gradually promoted and applied in pancreatic diseases, constantly affecting and changing the traditional mode of diagnosis and treatment of pancreatic diseases to digital intelligent mode.In order to better standardize the digital intelligent diagnosis and treatment of pancreatic diseases, on the basis of the "Expert consensus of precise diagnosis and treatment for pancreatic head cancer using three-dimensional visualization technology", Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association, and Digital Medical Branch of Chinese Medical Association,etc., organized domestic experts engaged in this field to formulate this expert consensus, focusing on revisions and supplements to introduce in detail the quality of 3D visualization, virtual reality, augmented reality, mixed reality and navigational surgery in the diagnosis and treatment of pancreatic surgical diseases.The control system and key points of clinical application are provided for the reference of pancreatic surgeons who are currently developing or preparing to develop digital intelligent technology, so as to better standardize and promote the clinical application of this technology.
Consensus ; Humans ; Imaging, Three-Dimensional/methods* ; Pancreatic Diseases ; Pancreatic Neoplasms/surgery*

Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.
Abdominal Abscess/surgery ; Drainage/*methods ; Endosonography/*methods ; Humans ; Necrosis/surgery ; Pancreas/*pathology/surgery ; Pancreatic Diseases/*surgery ; Pancreatic Pseudocyst/surgery ; *Stents ; Surgery, Computer-Assisted/*methods ; Ultrasonography, Interventional/methods

A report of a 67-year-old man, who had been suffering from an enterocutaneous fistula after a left hemicolectomy due to colon cancer is presented. He had sudden intermittent upper abdominal pain and a high amylase level in the drainage fluid. The fistulogram showed a colocutaneous fistula with an abnormal cavity in the left upper quadrant. ERCP was performed to demonstrate the relationship between the pancreatic duct and the colocutaneous fistula connected with the abnormal cavity, and showed a pancreatico-colo fistula which was connected with the abnormal cavity. From the results of the above two studies, a diagnosis of the pancreatico-colocutaneous fistula could be drained, and a distal pancreatectomy, splenectomy and closing of the colonic opening were performed. After the operation, the patient was discharged without problem. We report herein a case of pancreaticocolocutaneous fistula which was confirmed by ERCP preoperatively and surgically treated successfully.
Aged ; Colonic Diseases/*radiography/surgery ; Fistula/*radiography/surgery ; Humans ; Male ; Pancreatic Fistula/*radiography/surgery

OBJECTIVETo explore the improvement of typing and reasonable surgical treatment for pancreatic ductal stone (PDS).

METHODSTotally 89 patients with pancreatic ductul stone treated underwent surgeries from January 2000 to December 2012 were involved into this study. There were 57 male and 32 female patients, the average age was (52 ± 23) years. According to the magnetic resonance cholangiopancreatography imaging and finding during surgery, pancreatolithiasis was classified into three types: type I, the stones were located in the main pancreatic duct; type II, the stones were located both in main and branch pancreatic duct; type III, the stones were diffusely scattered in the branch pancreatic duct; the position of PDS within pancreatic parenchyma were subtitled. In this group, 43 type I PDS were extracted with endoscopic papillotomy or endoscopic pancreatic sphincterotomy, or pancreatolithotomy plus pancreato-jejunal lateral anastomosis with wide anastomotic stoma; 39 type II cases were treated by pancreatolithotomy plus pancreato-jejunal lateral anastomosis or/and resection of pancreatic section; 7 type III PDS were managed with resection of pancreatic section.

RESULTSAll surgeries were performed successfully. Among complications, 6 cases (6.7%) were pancreatic leakage which recovered after systematic non-surgical treatment, 2 cases (2.2%) were anastomotic bleeding which led to 1 death, 6 cases (6.7%) were residual pancreatolithiasis in branch pancreatic duct type. Seventy-eight patients were followed up for 6 to 131 months, 57 cases were still alive so far. Five cases were intermittent abdominal pain, 7 cases were diabetes resulted from 2 subtotal pancreatectomy and 5 distal pancreatectomy, 5 cases occurred pancreatolithiasis recurrence and 3 underwent secondary surgeries.

CONCLUSIONSThe basis of this modified typing of pancreatolithiasis is the position of stone in pancreatic duct rather than pancreas parenchyma. It is more important and valuable for surgical principle of taking stones out completely and maintaining pancreatic function.

Adult ; Calculi ; classification ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Diseases ; classification ; surgery ; Pancreatic Ducts ; pathology ; Sphincterotomy, Endoscopic ; Young Adult

BACKGROUND/AIMS: Although a few recent studies have reported the effectiveness of endoscopic pancreatic sphincterotomy (EPST), none has compared physicians' skills and complications resulting from the procedure. Thus, we examined the indications, complications, and safety of EPST performed by a single physician at a single center. METHODS: Among 2,313 patients who underwent endoscopic retrograde cholangiopancreatography between January 1996 and March 2008, 46 patients who underwent EPST were included in this retrospective study. We examined the indications, complications, safety, and effectiveness of EPST, as well as the need for a pancreatic drainage procedure and the concomitant application of EPST and endoscopic sphincterotomy (EST). RESULTS: Diagnostic indications for EPST were chronic pancreatitis (26 cases), pancreatic divisum (4 cases), and pancreatic cancer (8 cases). Therapeutic indications for EPST were removal of a pancreaticolith (10 cases), stent insertion for pancreatic duct stenosis (9 cases), nasopancreatic drainage (7 cases), and treatment of sphincter of Oddi dysfunction (1 case). The success rate of EPST was 95.7% (44/46). Acute complications of EPST included five cases (10.9%) of pancreatitis and one of cholangitis (2.2%). EPST with EST did not reduce biliary complications. Endoscopic pancreatic drainage procedures following EPST did not reduce pancreatic complications. CONCLUSIONS: EPST showed a low incidence of complications and a high rate of treatment success; thus, EPST is a relatively safe procedure that can be used to treat pancreatic diseases. Pancreatic drainage procedures and additional EST following EPST did not reduce the incidence of procedure-related complications.
Adult ; Aged ; Bile Ducts/surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Diseases/*surgery ; Pancreatic Ducts/surgery ; Sphincterotomy, Endoscopic/adverse effects/*methods

OBJECTIVETo evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreaticobiliary diseases and the characteristics of pancreaticobiliary disorders in children.

METHODRetrospective review was conducted on the data of patients younger than 18 years who underwent ERCP between 2005 and 2012 at West China Hospital. The indications,ERCP findings, ERCP procedures, complications, and clinical outcomes were evaluated.ERCP procedures were performed using standard duodenoscopes under general anaesthesia or sedation, which included all endoscopic treatments, such as endoscopic sphincteropapillotomy, stone extraction, stent treatment and so on.

RESULTOne hundred and two ERCPs were performed on 68 patients, and all the procedures were successfully completed in 100% cases. There were 39 girls (57%), and median age at time of procedure was 14.6 years (range, 5-17 years).General anesthesia and sedation were performed in 81% and 19% of procedures, respectively. The ERCP findings were classified as follows:bile duct stone(s) (n = 37, 54%), pancreatic duct stone(s) (n = 8, 12%), bile duct benign stricture (n = 7, 10%) and other nonmalignant pancreaticobiliary diseases (n = 16, 24%).Four cases (4/102, prevalence 4%) were complicated with post-ERCP pancreatitis.Symptoms such as abdominal pain and jaundice were cured obviously after the procedures of ERCP were performed.

CONCLUSIONThe main characteristics of pancreaticobiliary disorders in children were nonmalignant pancreaticobiliary diseases, such as bile duct stone, pancreatic duct stone, and bile/pancreatic duct benign stricture.When performed by well-trained endoscopists, ERCP is safe and effective in children.

Adolescent ; Biliary Tract Diseases ; diagnostic imaging ; surgery ; Calculi ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Pancreatic Diseases ; diagnosis ; pathology ; surgery ; Pancreatic Ducts ; diagnostic imaging ; surgery ; Retrospective Studies ; Treatment Outcome