0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Six of One, Half a Dozen of the Other:  Comment on “Surgical Treatment Strategies in Chronic Pancreatitis

Thomas J. Howard, MD
Arch Surg. 2012;147(10):969. doi:10.1001/2013.jamasurg.182.
Text Size: A A A
Published online

Extract

Yin and colleagues1 have done a great service to surgical pancreatologists by gathering 15 published studies (5 randomized and 10 nonrandomized) comparing duodenal-preserving pancreatic head resections (DPPHR; Beger and Frey operations) with standard resections (pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy) in patients with pain and chronic pancreatitis. They applied a sophisticated statistical meta-analysis using the defined protocols for the Preferred Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology. In pooling the Beger and Frey operations as DPPHR, the data clearly show that short- and long-term global quality of life were significantly better than the standard resections. This outcome is the primary objective in any intervention for chronic pancreatitis. Subgroup analysis, however, reveals the Beger operation achieves significantly better postoperative pain relief with perioperative morbidity similar to the standard resections, whereas the Frey operation has significantly lower perioperative morbidity but similar postoperative pain relief as the standard resection techniques. So which DPPHR operation does one use? The answer depends on the patient's anatomy and your surgical skill set. The Beger operation is technically more challenging, requiring transection of the pancreatic neck, a 90° rotation of the pancreatic head with subtotal pancreatic head resection, and 2 separate pancreaticojejunostomies (end-to-side and side-to-side), accounting for the equivalence of its perioperative morbidity with the standard resections. In contrast, the Frey operation does not require gland transection or rotation and the reconstruction is via a single long lateral pancreaticojejunostomy—improving postoperative morbidity but making adequate decompression of the uncinate process (the proverbial “pacemaker” of the disease) much more problematic, hence the pain relief profile similar to standard resections. As in much of surgery, honest skill assessment and intraoperative judgment are essential to improving the long-term global quality of life in our patients.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();