Surgeons vs' Gastroenterologist Surgeon vs' Surgeon

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Choubey Surgical options for pain
Controversies

• Surgeons vs. Gastroenterologist Surgeon vs.
  Surgeon
• 35 50 of all patients will require surgery at
  some time
• No surgical approach has 100 success
• Indications Intractable pain
• Local complications
• Pancreatic fistula and ascites
• Suspected carcinoma
• Progressive clinical deterioration
• Surgical options Drainage
• Resection
• Combined
• Nerve ablation
• No room for surgeons preference
• Indications for various options well established

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Choubey Surgical options for pain
Drainage procedures

• Predicated upon presence of dilated MPD (gt 6 mm )
• Dilated MPD implies intraductal hypertension
• compartment syndrome
• Advantages Simple and safe
• Preserve exocrine and endocrine functions
• Disadvantages Only 65 relief of pain at long
  term
• Drainage of head unsatisfactory
• Sphincteroplasty
• Caudal Pancreatico-jejunostomy (DuVal)
• Lateral Pancreatico-jejunostomy
  (Peustow-Gillesby,Partington-Rochelle)

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Choubey Surgical options for pain
Resection procedures

• Advantages ideal for localized disease
• takes care of pancreatic pain pacemaker
• better long term outcome
• Disadvantages technically difficult
• loss of pancreatic function
• Partial Classical Whipples PD
• PPPD
• Pancreatic left resection Partial
• Sub Total
• Total
• Organ Preserving DPPHR (Beger)

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Choubey Surgical options for pain
Combined (resection and drainage) procedures

• Freys
• Head coring with lateral PJ
• Izbicki
• V shaped ventral pancreatic
• resection and lateral PJ

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Choubey Surgical options for pain
Resection surgery outcome
AGA Technical review Gastroenterology
1998115765-776
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Choubey Surgical options for pain
Conclusions

• Surgery is the mainstay of treatment
• No room for surgeons preference
• Clear indications for various surgical options
• Organ preserving resectional and combined
  procedures are the best options.