review of literature on clinical pancreatology - The Pancreapedia

patients, can be performed with moderate mortality rates and should be considered inappropriate patients [271].PancreatogastrostomyPancreaticogastrostomy is a less used operation for drainage. In one seriespancreaticogastrostomy was done in 37 patients with dilated ducts during the period from2002-2008. Anastomosis <strong>of</strong> the pancreas to the posterior wall <strong>of</strong> stomach was performedusing pancreatic duct to gastric mucosa technique. The cases were followed up and it wasseen that pancreaticogastrostomy was an effective operation for chronic pancreatitis. Mostpatients (89 %) got relieved <strong>of</strong> pain for first several years. It is also a less time takingprocedure to perform as no Roux-en-y construction is needed [272].Longitudinal pancreatodjejunostomyObstruction <strong>of</strong> the main pancreatic duct in chronic pancreatitis (CP) leads to an increasedintraductal and intraparenchymal pressure causing pain. In one study it was evaluated theoutcome <strong>of</strong> surgical treatment <strong>of</strong> CP including the quality <strong>of</strong> life following Partington-Rochellepancreaticojejunostomy performed for intractable pain. Between 2002 and 2008, PRP themethod was performed in 17 patients in whom the diameter <strong>of</strong> the main pancreatic ductexceeded 7 mm and there was no inflammatory tumor in the pancreatic head. Perioperativemorbidity and mortality were analyzed in all patients. The long term outcome including thequality <strong>of</strong> life (Karn<strong>of</strong>sky index) was evaluated in 9 patients who were followed with a mean28 (range 13-60) months since surgery. Complications in the postoperative period werefound in 3 (18 %) patients including 1 death due to a myocardial infarction shortly aftersurgery. All patients submitted to the long-term evaluation reported a significant painreduction by an average <strong>of</strong> 6 (5-8) points in a 10-points visual analogue scale. The Karn<strong>of</strong>skyindex increased significantly from a mean 52 percent (40-70 %) before surgery up to 82percent (70-90 %) following surgery and long-term [273].Islet transplantationTransplantation <strong>of</strong> the whole pancreas or islet <strong>of</strong> Langerhans transplantation are alternativesto intensive insulin treatment, which decreases long-term complications at the cost <strong>of</strong> anincrease <strong>of</strong> severe hyoglycemia. Pancreas transplantation, indicated mainly to diabeticpatients with simultaneous kidney transplantation, has a high success rate, but isaccompanied by high morbidity due to general surgery. Islet transplantation, a cell-therapyfor type 1 diabetes, is in full development. It is mainly indicated as islet transplant alone inpatients suffering from brittle diabetes, and is associated with a very low risk due to minimallyinvasive technique, but a lower rate <strong>of</strong> long-term success. New potential sources <strong>of</strong> beta cellreplacement are beta-cell lines, stem cells and xenotransplantation [274].Intraportal autotransplantationThe probability <strong>of</strong> insulin independence after intraportal islet autotransplantation (IAT) forchronic pancreatitis treated by total pancreatectomy relates to the number <strong>of</strong> islets isolatedfrom the excised pancreas. The goal <strong>of</strong> one study was to correlate the islet yield with thehistopathologic findings and the clinical parameters in pediatric (age,