the surgery of chronic pancreatitis, pancreas peseudocysts szentkereszty zs. md. phd., med. habil....
TRANSCRIPT
![Page 1: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/1.jpg)
The surgery of chronic pancreatitis, pancreas The surgery of chronic pancreatitis, pancreas peseudocystspeseudocysts
Szentkereszty Zs. MD. PhD., Med. habil.
UD MHSC Inst. Of Surgery
![Page 2: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/2.jpg)
Chronic pancreatitisChronic pancreatitis
1. Sclerosis of the pancreas
2. Gland atrophy - Focal
- segmental
- diffuse
Protein extraction – calcification
Duct dilatation– intraductal hypertension
![Page 3: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/3.jpg)
LocalisationLocalisation
- Mosttly in the head of the pancreas( Guillemin, Traverso és Longmire, Beger)
- A „Rinnen” és „groove” pancreatitis-In the head
( Stolte, Becker)
- The predilective localisation of the tumours are also in the head of the pancreas
( Cubilla és Fitzgerald, Hertzberg, Nakase és mtsai, Spohn és mtsai)
![Page 4: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/4.jpg)
EtiologyEtiology
- Alimentaion:fatty foods, abundant mealsalcoholism
- Developement of diagnosispancreas functional
testsimagies
![Page 5: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/5.jpg)
ComplaintsComplaints
- Pain- Dypepsia- Weigh loss- Jaundice- Ascites- Duodenal obstraction- Diabetes
![Page 6: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/6.jpg)
ImagiesImagies
- Gastrio-duodenal passage- Pancreas ultrasonography- Pancreas scintigraphy- CT, MRI- ERCP- MRCP
![Page 7: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/7.jpg)
NORMAL ERCP VIEWNORMAL ERCP VIEW
![Page 8: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/8.jpg)
VATER PAPILLA OBSTURCTIONVATER PAPILLA OBSTURCTION
![Page 9: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/9.jpg)
„„CHAIN OF LAKES”CHAIN OF LAKES”
![Page 10: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/10.jpg)
CALIBER IRREGULARITY, CALIBER IRREGULARITY, PSEUDOCYSPSEUDOCYS
![Page 11: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/11.jpg)
PSEUDOCYS, CONNECTION WITH PSEUDOCYS, CONNECTION WITH THE PANCREATIC DUCTTHE PANCREATIC DUCT
![Page 12: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/12.jpg)
PSEUDOCYSTPSEUDOCYST
![Page 13: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/13.jpg)
PSEUDOCYST, SEGMENTAL PSEUDOCYST, SEGMENTAL DUCTECTASYDUCTECTASY
![Page 14: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/14.jpg)
PSEUDOCYST IN THE HEADPSEUDOCYST IN THE HEAD
![Page 15: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/15.jpg)
INDICATION OF SURGERY IN CHR. INDICATION OF SURGERY IN CHR. PANCREATITISPANCREATITIS
PainAcute exacerbationsComplications:
Jaundiceduodenal obstractionpseudocystspancreas
fistuleSuspition of cancer
x
![Page 16: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/16.jpg)
SOME WORDS ABOUT THE SOME WORDS ABOUT THE SURGICAL TREATMENTSURGICAL TREATMENT
- It is symptomatic treatment
- The stop of etiology does not prevent the progression
- The alcohol free lifestyle is needed for the surgery
![Page 17: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/17.jpg)
CHOICE OF TYPE OF THE SURGICAL CHOICE OF TYPE OF THE SURGICAL PROCEDUREPROCEDURE
The duct morphology is important
In general:
1. in case of dilatated duct decompressive surgery is needed
2. In cese of segmental, or focal inflammation resection is needed
Imagies:
US
CT
ERCP
MRCP
![Page 18: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/18.jpg)
CHOICE OF SURGICAL PROCEDURES
- There is no generally used gold standard
- Organ save methods are better?
- The resections have a 5% of mortality rate
- The decompressive operations have lower rate of mortality
![Page 19: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/19.jpg)
DRAINAGE OPERATIONS
- The drainage of the pancreatic juice- Decrease of the intraductal pressure
Types of decompressive operations
- longitudinal pancreaticojejunostomy- longitudinal pancreaticogastrostomy - Cyst drainage with the aboves- Pancreas head partzial resection and pancreat(ic)o-
jejunostomy
![Page 20: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/20.jpg)
A LONGITUDINAL PANCREATO CYSTO-A LONGITUDINAL PANCREATO CYSTO-GASTROSTOMIAGASTROSTOMIA
![Page 21: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/21.jpg)
RESECTIONSRESECTIONS
- Resection of the advanced local destruction- Resection of the duct destructions- Treatment of the local compresive complaints
Types of resectionsTypes of resections
- Whipple pancreatoduodenectomy- Pylorus – preserving pancreatoduodenectomy (PPPD)- Duodenum preserving pancreas head resection
![Page 22: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/22.jpg)
PANCREAS-CYSTSPANCREAS-CYSTS
Definition true cyst
pseudocyst
Pathológic forms: 1. Genetic abnormalities
pl. fibrocystic pancreas, dermoid cyst
2. retentional cysts
3. parasitic cysts (hydatid)
4. neoplastic cysts
( cystadenoma, cystadenocarcinoma, teratoma)
5. pseudocysts
![Page 23: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/23.jpg)
PANCREAS-CYSTSPANCREAS-CYSTS
![Page 24: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/24.jpg)
PANCREAS-PSEUDOCYSTSPANCREAS-PSEUDOCYSTS
Localisation: pancreas headpancreas body pancreas tail
Complaint: dullnessPainduodenal obstruction
Diagnosis: USCT
Surgery: 1. decompression: cysto-duodenostomycysto-gastrostomycysto-jejunostomy2. resection3. External drainage4. Internal drainage (ERCP)
![Page 25: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/25.jpg)
PANCREAS-PSEUDOCYSTSPANCREAS-PSEUDOCYSTS
![Page 26: The surgery of chronic pancreatitis, pancreas peseudocysts Szentkereszty Zs. MD. PhD., Med. habil. UD MHSC Inst. Of Surgery](https://reader038.vdocuments.mx/reader038/viewer/2022110206/56649d005503460f949d171e/html5/thumbnails/26.jpg)
Thank You for your attention!Thank You for your attention!