Pancreaticojejunostomy: A Case Study
Treatment Currently the only curative therapy for PDAC is complete surgical resection. Unfortunately due to the aggressive nature of this disease, only 15- 20% of diagnosed patients undergo surgical resection (Al-Hawary et al., 2013a; Castellanos & Merchant, 2013). Of those who do undergo resection, the average survival time for the patient is only 12-20 months (Brouda, 2010). Once a patient has been deemed with a resectable tumor, the type of surgery they will undergo will depend on the location of the tumor (Gall, Tsakok, Wasan & Jiao, 2015). A tumor located in the uncinated process or right of the SMV in the pancreatic head, which is about 60% of the tumors, are potentially suitable for a Whipple procedure, otherwise known as a pancreaticoduodenectomy
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After the removal of these structures three anastomoses are required to be made. In order to reconnect the remaining pancreas and main pancreatic duct, a pancreaticogastrostomy or pancreaticojejunostomy will be performed; a gastrojejunostomy will be placed to reconnect the post pylorus duodenum to the jejunum or a duodenojejunostomy to reconnect post pylorus to jejunum in a PPPD procedure; and a hepaticojejunostomy to reconnect the common hepatic duct of the GI tract (Gall et Al., 2015; Shroff et al., 2011). Most common problems following surgery include delayed gastric emptying, postoperative pancreatic fistulas and wound infections (Gall et al., …show more content…
Unfortunately, even those with a resectable tumor have a poor survival rate and a high recurrence rate. The use of a combination of the different imaging modalities is important in order to diagnose and stage PDAC, as well as provide the basis if the tumor is resectable or not. Each modality has something to offer but overall CT remains the most commonly used modality for diagnosing and staging. CT allows for quick scans and provides radiologists with cross-sectional images that are key to determining the resectability of the tumor. CT is also the primary modality used for follow-up imaging after a patient has undergone a
After the removal of these structures three anastomoses are required to be made. In order to reconnect the remaining pancreas and main pancreatic duct, a pancreaticogastrostomy or pancreaticojejunostomy will be performed; a gastrojejunostomy will be placed to reconnect the post pylorus duodenum to the jejunum or a duodenojejunostomy to reconnect post pylorus to jejunum in a PPPD procedure; and a hepaticojejunostomy to reconnect the common hepatic duct of the GI tract (Gall et Al., 2015; Shroff et al., 2011). Most common problems following surgery include delayed gastric emptying, postoperative pancreatic fistulas and wound infections (Gall et al., …show more content…
Unfortunately, even those with a resectable tumor have a poor survival rate and a high recurrence rate. The use of a combination of the different imaging modalities is important in order to diagnose and stage PDAC, as well as provide the basis if the tumor is resectable or not. Each modality has something to offer but overall CT remains the most commonly used modality for diagnosing and staging. CT allows for quick scans and provides radiologists with cross-sectional images that are key to determining the resectability of the tumor. CT is also the primary modality used for follow-up imaging after a patient has undergone a