Journal of Surgery

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Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension

Received: 29 June 2015    Accepted: 06 July 2015    Published: 17 July 2015
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Abstract

Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser and double balloon enteroscopy (DBE) technologies for its relief. Materials and methods: Pancreatojejunoanastomosis (PJA) lumen was examined using the videoenteroscope EN-450P5/20 (Fujifilm group, Fujinon Co, Tokio, Japan) for the first time in the world. All 20 patients had had CP and underwent an elective surgery earlier. During 2010-2014, 198 resections were performed, with 159 (80,3%) being laser drainage procedures. Results: DBE revealed strictures of PJA and open common bile duct, residual pancreatoliths in PJA lumen, and PJA leakage. After DBE laser lithotripsy of pancreatoliths in tributary ducts, a free outflow of pancreatic juice from the lumen was obtained. DBE findings were supported by the morphological study of excised pancreatic specimen, CT-scans before the surgery and the staining of PJA lumen. All these data suggest that 17,7% of CP patients along with magistral ductal hypertension had peripheral ductal hypertension (PDH), which seems to be a new cause of severe abdominalgia. The latter arises when pancreatoliths block the orifices of tributary ducts. For reducing the PDH, we have developed a new surgical procedure named «laser cylindric wirsungectomy» (n=26) and proposed our own classification of pancreatic duct stones. Conclusions: DBE has great opportunities for the diagnosis of complications and their mini-invasive treatment after pancreatojejunostomy (PJ). Laser technologies are considered to be a new approach to the effective open and mini-invasive surgical treatment of CP.

DOI 10.11648/j.js.20150304.11
Published in Journal of Surgery (Volume 3, Issue 4, August 2015)
Page(s) 32-38
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Double Balloon Enteroscopy, Pancreatojejunostomy, Laser, Lithotripsy

References
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[3] Buchler M, Weihe E, Friess H, Malfertheiner P, Bockman E, Muller S, Nohr D, Beger HG. Changes in peptidergic innervation in chronic pancreatitis. Pancreas 1992; 7 (2): 183-192.
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[14] Schneider A, Lohr S, Singer M. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. Gastroenterol 2007; 42: 1-19.
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[17] Frey CF, Kathrin L, Mayer M. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreas head (Beger procedure). World J Surg 2003; 27: 1217-1230.
[18] Beger HG, Schlosser W, Friess HM, Buchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single- center 26-year experience. Ann Surg., 1999; 230: 512-519.
[19] Gloor B, Friess H, Uhl W, Buchler M. A modified technique of the Beger and Frey procedure in patient with chronic pancreatitis. Digest Surg 2001; 18: 21-25.
[20] Varabei A, Shuleika A, Arlouski Y, Vizhinis Y, Lagodich N. Tributaryliths as a reason of peripheral pancreatic hypertension in chronic pancreatitis. Proceeding of the 45th Meeting of the EPC. Zurich. 26-29 June 2013. Pancreatol 13 (39): 556.
[21] Yamamoto H, Sugano K. A new method of enteroscopy - the double balloon method. Can J Gastroenterol 2003; 17: 4, 273-274.
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[23] Parlak E, Cicek B, Disibeyaz S. Endoscopic retrograde cholangiography by double balloon endoscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc 2009; 6: 45-47.
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Author Information
  • Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus

  • Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus

  • Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus

  • Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus

  • Minsk Regional Clinical Hospital, Endoscopy Unit, Minsk, Belarus

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    Aliaksandr Varabei, Anatoli Shuleika, Yury Vizhinis, Yury Arlouski, Natalia Lagodich. (2015). Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension. Journal of Surgery, 3(4), 32-38. https://doi.org/10.11648/j.js.20150304.11

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    ACS Style

    Aliaksandr Varabei; Anatoli Shuleika; Yury Vizhinis; Yury Arlouski; Natalia Lagodich. Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension. J. Surg. 2015, 3(4), 32-38. doi: 10.11648/j.js.20150304.11

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    AMA Style

    Aliaksandr Varabei, Anatoli Shuleika, Yury Vizhinis, Yury Arlouski, Natalia Lagodich. Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension. J Surg. 2015;3(4):32-38. doi: 10.11648/j.js.20150304.11

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  • @article{10.11648/j.js.20150304.11,
      author = {Aliaksandr Varabei and Anatoli Shuleika and Yury Vizhinis and Yury Arlouski and Natalia Lagodich},
      title = {Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension},
      journal = {Journal of Surgery},
      volume = {3},
      number = {4},
      pages = {32-38},
      doi = {10.11648/j.js.20150304.11},
      url = {https://doi.org/10.11648/j.js.20150304.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.js.20150304.11},
      abstract = {Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser and double balloon enteroscopy (DBE) technologies for its relief. Materials and methods: Pancreatojejunoanastomosis (PJA) lumen was examined using the videoenteroscope EN-450P5/20 (Fujifilm group, Fujinon Co, Tokio, Japan) for the first time in the world. All 20 patients had had CP and underwent an elective surgery earlier. During 2010-2014, 198 resections were performed, with 159 (80,3%) being laser drainage procedures. Results: DBE revealed strictures of PJA and open common bile duct, residual pancreatoliths in PJA lumen, and PJA leakage. After DBE laser lithotripsy of pancreatoliths in tributary ducts, a free outflow of pancreatic juice from the lumen was obtained. DBE findings were supported by the morphological study of excised pancreatic specimen, CT-scans before the surgery and the staining of PJA lumen. All these data suggest that 17,7% of CP patients along with magistral ductal hypertension had peripheral ductal hypertension (PDH), which seems to be a new cause of severe abdominalgia. The latter arises when pancreatoliths block the orifices of tributary ducts. For reducing the PDH, we have developed a new surgical procedure named «laser cylindric wirsungectomy» (n=26) and proposed our own classification of pancreatic duct stones. Conclusions: DBE has great opportunities for the diagnosis of complications and their mini-invasive treatment after pancreatojejunostomy (PJ). Laser technologies are considered to be a new approach to the effective open and mini-invasive surgical treatment of CP.},
     year = {2015}
    }
    

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  • TY  - JOUR
    T1  - Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension
    AU  - Aliaksandr Varabei
    AU  - Anatoli Shuleika
    AU  - Yury Vizhinis
    AU  - Yury Arlouski
    AU  - Natalia Lagodich
    Y1  - 2015/07/17
    PY  - 2015
    N1  - https://doi.org/10.11648/j.js.20150304.11
    DO  - 10.11648/j.js.20150304.11
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 32
    EP  - 38
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20150304.11
    AB  - Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser and double balloon enteroscopy (DBE) technologies for its relief. Materials and methods: Pancreatojejunoanastomosis (PJA) lumen was examined using the videoenteroscope EN-450P5/20 (Fujifilm group, Fujinon Co, Tokio, Japan) for the first time in the world. All 20 patients had had CP and underwent an elective surgery earlier. During 2010-2014, 198 resections were performed, with 159 (80,3%) being laser drainage procedures. Results: DBE revealed strictures of PJA and open common bile duct, residual pancreatoliths in PJA lumen, and PJA leakage. After DBE laser lithotripsy of pancreatoliths in tributary ducts, a free outflow of pancreatic juice from the lumen was obtained. DBE findings were supported by the morphological study of excised pancreatic specimen, CT-scans before the surgery and the staining of PJA lumen. All these data suggest that 17,7% of CP patients along with magistral ductal hypertension had peripheral ductal hypertension (PDH), which seems to be a new cause of severe abdominalgia. The latter arises when pancreatoliths block the orifices of tributary ducts. For reducing the PDH, we have developed a new surgical procedure named «laser cylindric wirsungectomy» (n=26) and proposed our own classification of pancreatic duct stones. Conclusions: DBE has great opportunities for the diagnosis of complications and their mini-invasive treatment after pancreatojejunostomy (PJ). Laser technologies are considered to be a new approach to the effective open and mini-invasive surgical treatment of CP.
    VL  - 3
    IS  - 4
    ER  - 

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