CHRONIC_PANCREATITIS ppt Dr Atul Kumar MS general surgeon

Medical disease

1. CHRONIC PANCREATITIS

2. Indications for Surgery in Chronic Pancreatitis Intractable pain Pancreatic ductal stenosis Biliary obstruction Duodenal obstruction Left sided portal hypertension from splenic vein thrombosis Colonic obstruction Pseudocyst Pancreatic ascites Pancreatic fistula Pancreatic carcinoma

3. SURGICAL TREATMENT OF CHRONIC PANCREATITIS The type of operation depends on parenchymal and pancreatic ductal morphological changes of pancreas and can be divided into Pancreatic duct drainage procedures Pancreatic resection procedures

4. It is generally recommended that the operation should only be performed in patients with pancreatic ducts larger than 7 mm in diameter. Lateral Pancreatico-Jejunostomy ( Modified Puestow Procedure) PANCREATIC DUCT DRAINAGE PROCEDURES

5. Frey Procedure: coring of the head of pancreas with lateral pancreatico-jejunostomy . This operation indicated when the head of the pancreas is enlarged 3-4 cm or more in anterior-posterior diameter with dilated pancreatic duct. PANCREATIC DUCT DRAINAGE PROCEDURES

6. PANCREATIC RESECTION PROCEDURES: In up to 30% of patients with chronic pancreatitis, the head of the gland will grossly enlarged by an inflammatory mass Often associated with bile duct stenosis and duodenal hold up. In these patients some form of pancreatic head resection is indicated even in the presence of gross pancreatic duct dilatation:  Whipple operation  Pylorus preserving pancreaticoduodenectomy  Duodenal preserving resection of the head of pancreas ( Beger Procedure)