383 research outputs found
The Dagradi-Serio-Iacono operation central pancreatectomy
No full textCentral pancreatectomy (CP) is a segmental pancreatic resection indicated to remove benign or low-grade malignant
tumors of the isthmus and proximal part of the body of the pancreas. The main advantage of this operation compared with major
resections is that it permits to spare normal pancreatic parenchyma;moreover, spleen and upper digestive and biliary tracts are saved.
The description of the complete operation was reported for the first time by Dagradi and Serio in 1984 and subsequently spread
worldwide by Iacono and Serio. In our opinion, it should be called the Dagradi–Serio–Iacono operation, by the names of the
surgeons who first performed it (Dagradi and Serio), and by the names of the surgeons responsible for reporting it worldwide
with precise indications (Iacono and Serio). Operation requires a midline or a bilateral subcostal incision; the lesser sac is entered
through dissection of the transverse colon from the omentum or by transecting the gastrocolic ligament. The pancreatic segment
harboring the lesion is then mobilized and its posterior surface carefully dissected from the splenic vein and artery. Subsequently,
the pancreatic portion harboring the tumor is isolated at its superior margin from the splenic artery after the pancreas is transacted.
The extent of the resection of the central segment is limited on the right by the gastroduodenal artery and on the left by the need
to leave at least 5 cm of normal pancreatic remnant. The resected pancreatic specimen is sent to the pathologist for confirmation
of diagnosis and to check if the resection margins are adequate. Hemostasis of the two raw surfaces is achieved with interrupted 5
or 4/0 nonabsorbable stitches. When it is not stapled, theWirsung’s duct of the cephalic stump is sutured selectively with a figureof-
eight nonabsorbable stitch. An end-to-end invaginated pancreaticojejunostomy is carried out with a single layer of interrupted
stitches. The operation is concluded with the construction of an end-to-side jejuno-jejunostomy about 50 cm distal to the
pancreatic anastomosis. Other techniques for reconstruction of the distal stump using jejunum or stomach have been described.
One or two soft drains are brought out on the right side. The fluid collected from this drain is checked for amylase level on
postoperative days 3, 5, and 7; if the level is low or absent, the drain is removed. Central pancreatectomy is a safe technique for
benign or low malignant tumors of the pancreatic neck that allows curing the tumor with evident functional results without
increasing the risk for the patient. We can say that CP has a clear role like pancreaticoduodenectomy and distal pancreatectomy
and we think that a pancreatic surgeon has to include this procedure in his/her technical skills. In order to obtain excellent results,
correct indications and experience in pancreatic surgery are recommended
Central pancreatectomy: the Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach.
No full textCentral pancreatectomy (CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection (SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot (1957) and Letton and Wilson (1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came
ASO Author Reflections: Hepatopancreatoduodenectomy: Why, When, and How?
No full textHepatopancreatoduodenectomy: Why, When, and How
Chirurgia della pancreatite acuta. Indicazioni, timing e risultati dell’intervento chirurgico
No full textOrgan- and Parenchyma-sparing Pancreatic Surgery
No full textconventional pancreatectomies, such as pancreaticoduodenectomy and distal and total pancreatectomy, result in an important loss of normal pancreatic parenchyma and the nearby organs (spleen, upper digestive tract, and common bile duct). In addition, these procedures involve significant mortality, high morbidity, and long-term disorders, including infections, thromboembolic complications, digestive disorders, pancreatic exocrine insufficiency, and diabetes. Although conventional pancreatectomies are mandatory for malignant tumor, they are an overtreatment for benign tumors as healthy functional pancreatic parenchyma is sacrificed, especially in young patients with long life expectancy. Unfortunately, enucleation is not always advisable in lesions of uncertain histology or those deeply located in the pancreatic gland owing to the risk of a positive surgical margin or injury to the main pancreatic duct, respectively. Since the 1980s, the prospects for pancreatic resection have widened with the development of organ-and parenchyma-sparing pancreatic surgery (OPSPS) for benign or low-grade malignant tumors involving isolated or multiple segments of the pancreas. New operations, such as spleen-preserving distal pancreatectomy, duodenum-sparing pancreas head resection, dorsal pancreatectomy, resection of the ventral or uncinate process of the pancreas, middle-preserving pancreatectomy, and central pancreatectomy (the Dagradi-Serio-Iacono operation), aim to preserve pancreatic exocrine and endocrine function, spare the nearby organs, ensure oncological radicality, and achieve better quality of life after surgery. In fact, according to vascular anatomy and embryological development, the pancreatic gland is divided in four segments and each of these can be resected independently. In experienced hands, OPSPS is technically feasible and can be performed with low mortality. Early morbidity is greater than that achieved using standard resection owing to the high rate of postoperative pancreatic fistula. However, most of these pancreatic leakages are managed conservatively. Furthermore, possible poor short-term outcomes are counterbalanced by the preservation of pancreatic endocrine and exocrine function and the low rate of reoperations for tumor recurrence. Currently, OPSPS can also be performed by laparoscopic or robotic approach achieving better results in term of blood loss, operative time, hospital stay, recovery and scarring. Careful case selection, accurate pre-and intraoperative evaluation of the lesion, and experience in pancreatic surgery are required for optimal results
Is there a place for central pancreatectomy in pancreatic surgery?
No full textTumors located in the neck of the pancreas that are not small and superficial enough to be enucleated are usually resected with a pancreaticoduodenectomy or left splenopancreatectomy. Such operations may cause digestive disorders, glucose intolerance, and late postsplenectomy infection. Central pancreatectomy is a segmental resection whereby the cephalic stump is sutured and the distal stump anastomosed with a Roux-en-Y jejunal loop. The purpose of this study was to evaluate whether central pancreatectomy has a place in pancreatic surgery. Thirteen patients with the following tumors underwent central pancreatectomy: five endocrine tumors, one mucinous and six serous cystadenomas, and one solid cystic-papillary tumor. Mean operative time was 250 minutes. Operative mortality was zero. Complications occurred in three patients (23\%). At mean follow-up of 68 months, no recurrences were found. Postoperative oral glucose tolerance, pancreolauryl, and fecal fat excretion tests were normal in all patients. We believe that central pancreatectomy does have a place in pancreatic surgery; it is a reliable technique for benign or low-grade malignant tumors and has a surgical risk similar to that of standard operations. Its principal advantage is that it preserves pancreatic parenchyma and the anatomy of the upper gastrointestinal and biliary tract and the spleen better than pancreaticoduodenectomy or distal pancreatic and splenic resection. (J Gastrointest Surg 1998;2:509-517.
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