The aim of this article is to represent our new surgical technique and methods applied in the treatment of infected pancreatic necrosis, chronic pancreatitis, and islet transplantation from 1986.
Infected pancreatic necrosis (IPN), the most severe form of acute pancreatitis, is responsible for most cases of pancreatitis-related morbidity and high mortality. Since 1986, 224 patients with IPN have been treated. The surgical treatment consisted of wide-ranging necrosectomy, combined with widespread drainage and continuous lavage. Following surgery supportive therapy was applied. The overall hospital mortality was 7.7%. In our experience, IPN responds well to the complex treatment, consisting of adequate surgery, continuous, longstanding widespread drainage and lavage, together with supportive therapy.
In chronic pancreatitis (CP), enlargement of the head of the pancreas develops as a consequence of inflammatory alterations. A new safe procedure has been developed for duodenum and organ-preserving pancreatic head resection. The surgical procedure consisted of a local resection of the inflammatory tumour in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. This operation was performed on 196 patients. No mortality was detected in the postoperative period. The mean follow-up time was 6.3 years. The QoL improved in 89% of the cases. The results reveal that this organ-preserving pancreatic head resection is a safe and effective procedure for definitive control of the complications following the inflammatory alterations of CP.
The most common complication in distal pancreatectomy is the occurrence of a postoperative pancreatic fistula (POPF). The fistula rate of 30% in the multicenter trial demonstrated that the currently applied techniques for closure of the pancreas remnant do not always lead to perfect results. Staples made from PolysorbR, an absorbable lactomer, have been applied in our practice in 187 patients following distal resection to reduce these complications. The incidence of POPF was 0.6%. Our clinical results demonstrated that the application of absorbable lactomer staples is a safe alternative to the standard closure technique and can be applied in all cases when distal pancreatic resection is indicated.
Human foetal pancreatic islets has long been viewed as an attractive source of tissue for transplantation in diabetic patients. Foetal pancreas has a high ratio for endocrine tissue and a longer period of tissue culture allows the proliferation of islets. The organ culture also provides the opportunity for reducing the immunogenicity of islets. Unfortunately, this quantity of islets is not enough for a complete cure of the diabetic condition in one recipient, but in combination with cryopreserved islet tissues, it may provide an opportunity for the treatment of diabetes mellitus. In our clinical practice, long-term cultured and cryopreserved islets were applied for transplantations of 25 diabetic patients. After grafting the insulin requirement decreased significantly and the normoglycemic condition prevents, stabilizes, or reverses the secondary complications if it can be performed at a relatively early stage of the diabetes.
FarkasGy, MártonJ, MándiY, SzederkényiE. Surgical strategy and management of infected pancreatic necrosis. Br J Surg1996; 83(7): 930–3.
FarkasGy, LeindlerL, DarócziM, FarkasGyJr. Ten-year experience with duodenum and organ-preserving pancreatic head resection in the surgical treatment of chronic pancreatitis. Pancreas2010; 39(7): 1082–7.
FarkasGy, LeindlerL, DarócziM, FarkasGyJr. Ten-year experience with duodenum and organ-preserving pancreatic head resection in the surgical treatment of chronic pancreatitis. Pancreas
2010; 39(7): 1082–7.10.1097/MPA.0b013e3181d3727b)| false
FarkasGy. Long-term studies with cultured and cryopreserved human fetal islets for islet transplantation in Hungary. In: PetersonCh M, Jovanovic-PetersonL, FormbyB, editors. Fetal islet transplantation. London – New York: Plenum Press; 1995. pp. 99–111.
FarkasGy. Long-term studies with cultured and cryopreserved human fetal islets for islet transplantation in Hungary. In: PetersonCh M, Jovanovic-PetersonL, FormbyB, editors. Fetal islet transplantation. London – New York: Plenum Press; 1995. pp. 99–111.10.1007/978-1-4615-1981-2_9)| false