M Tufail, HJ Majid, HM Dar, A Javed.
Pancreatico-duodenectomy for Periampullary Carcinoma - A Five Years Experience.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;14(2):63-70.
This prospective study was carried out over a five year period (1993 to 1997) at the Department of Surgery Unit-11, Shaikh Zayed Hospital, Lahore. Twenty patients underwent pancreatico-duodenal resection for suspected periampullary carcinoma. The mean age in the study group was 48 years (range 8-70 years). Males outnumbered the females (3:1). Painless progressive jaundice, pruritis and weight loss were the main presenting corn/Taints. Three patients had already had palliative by-pass procedures done elsewhere and were admitted either for persistent pain or cholangitis. Hyperbilirubinemia and raised alkaline phosphatase were significant biochemical findings in all patients. Fourteen patients were diabetic. Ultrasound was useful in 18 (90%) cases. ERCP was diagnostic in half of the patients. Two patients had palliative stenting preoperatively by ERCP. Whipple`s pancreatico-duodenectomy was done in 19 patients while one patient had pylorus preserving pancreatico-duodenectomy. Two methods were adopted for pancreatico jejunal anastomosis. In 16 patients pancreatic duct mucosa was anastomosed to jejunal mucosa. Telescoping panereatico jejunal (`finger oil glove`) anastomosis was employed in 3 patients with undilated pancreatic duct. One patient had pancreatic duct ligation. Pancreatic leakage occurred in one patient. Early reoperation was done in one patient for mesenteric vein thrombosis. There were 4 deaths in the study group. Four (20%) of patients are still alive, 4 years after surgery. This study favours pancreatico-duodenectomy as the surgical option of choice for periampullary carcinoma, not only for palliation but also to improve survival. However, a larger study should be carried out.
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