CBD and Pancreatic duct obstruction - Forum

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Noro

Re: CBD and Pancreatic duct obstruction - Ärzteforum

Post#11 »

Now we are confusing the discussion ! Didn't we talk on cholecysto-jejunostomy? who is talking on CBD-bowel anastomosis?

I do not have a large personal experience with the surgical management of pain or jaundice in chronic pancreatitis. My understanding however is that when severe pain is combined with jaundice something more than biliary bypass should be done at the same time. The patients under discussion presented with pain and jaundice-thus, I suggested that simple bypass won't suffice. I am sure that you are aware about the large experience with the DUODENAL PRESERVING partial resection of the head -combined with a pancreatico-jejunostomy- pioneered by Frey from Michigan and Beger from Ulm. Izbiki from Hamburg wrote a very large series with Begers operation. Many experts believe that this is the best operation for the painful/jaundiced/ chronic pancreatitis.


Now you are shooting indiscriminately-as a GI send to shoot the Iraqis, firing instead on the Israelis. Did I mention any outdated surgery from outdated books? Please update yourself with recent developments on chronic pancreatitis.


Jorjo

Re: CBD and Pancreatic duct obstruction - Ärzteforum

Post#12 »

I agree with pancreaticoduodenectomy, in this case is the best operation also for the qality residual life.

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Resident

Re: CBD and Pancreatic duct obstruction - Ärzteforum

Post#13 »

In the case, the duodenum easily mobilized for a choledolchoduodenostomy. As pionted out this is usually the case. Puestow for pancreatic drainage. Would anybody consider using a single roux limb for both anastamoses? Is biliary flow past the pancreatic duct a real or a theoretic source of morbidity?

I think the residents predisposition to "imagining scenarios..." reflects the attendings predisposition to presenting scenarios - in the legacy of Dr. Hardy's teaching style.

Appreciate the input.

Patient has already been discharged, tolerating a diet and pain free.

Noro

Re: CBD and Pancreatic duct obstruction - Ärzteforum

Post#14 »

Glad to see you guys went the sensible way, altho I will say once again there may have been no reason to also do the Puestow--do one thing at a time and save the patient another operation if his symptoms resolve. Anyway--a great case for a chief resident! No, I would not use the same loop for both anastomoses--unnecessarily complex. Now you see for yourself how the recommendation for pancreatectomy is gross and unnecessary overkill--see what the guys who recommended that now think seeing how well the patient did without it!

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Doctor Green

Re: CBD and Pancreatic duct obstruction - Ärzteforum

Post#15 »

I'm glad the double duct obstruction pt is doing well. Would withold final judgment until after a number of months have passed off of pain meds before condemning resection in this setting. There is still good evidence out there for PD in pts with symptomatic chronic pancreatitis of pancreatic head.

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