Chronic pancreatitis surgeries Flashcards
What is a Puestow procedure?
longitudinal pancreaticojejunostomy
what is a Puestow done for?
chronic pancreatitis with dilation of the pancreatic duct >7 mm with no pancreatic head involvement
What is this?
Puestow procedure
(longitudinal pancreaticojejunostomy)
What is this?
Frey Procedure (core out the head w/longitudinal dissection of pancreatic duct towards the tail, recon w/RNY PJ)
What procedure would you use for a dilated distal duct >7 mm and enlarged pancreatic head?
Frey Procedure (core out the head w/longitudinal dissection of pancreatic duct towards the tail, recon w/RNY PJ)
What is a Bern procedure?
Beger procedure modification where pancreas is NOT transected at the level of the portal vein
Does the Bern have similar outcomes to Beger?
Yes
Head is dissected to the level of the portal vein and cored out leaving behind rim of pancreatic tissue abutting duodenum. 2 anastomoses with RNY jejunal loop to pancreatic tail remnant (end to side) and to excavated pancreatic head (side to side)
Beger procedure
Typically reserved for large inflammatory head of the pancreas with no ductal dilation
Beger or Bern
what is a Whipple?
resection of pancreatic head, duodenum, and distal once third of stomach. Recon with GJ, PJ, HJ.
What is the Beger also known as?
duodenum preserving pancreatic head resection
what is the cause of pancreas divisium?
failure for correct fusion of the dorsal and ventral buds of the pancreas in utero. majority will have pancreas drain through the accessory duct and the minor papilla resulting in chronically elevated pressure int the pancreatic duct (chronic pancreatitis)
How do you diagnose pancreas divisium
MRCP
what is this?
Pancreas divisium
