Special therapeutic procedures
The remarkable progress of radiologic, endoscopic and isotopic technology in the last few years, nowadays permits an outstanding diagnostic capacity in medical processes located at any organ of the digestive system. Precise diagnosis of the pancreas has always been difficult due to its anatomic location; however, it is not excluded from the progress made.
Accordingly, there has been a remarkable increase in the diagnosis of this type of pathology which does not cause any symptom, but means an evident potential for present and future malignancy. Processes such as cystic pancreatic injuries or early ductal neuroendocrine tumors can now be diagnosed with great accuracy.
This diagnostic improvement is accompanied by an important modification of surgical procedures. A radical and mutilating surgical treatment used to be the answer to any pancreatic injury regardless of its nature, but nowadays a functional and conservative surgery associated to small functional postoperative consequences is preferred.
This type of surgery is specially recommended for neoplastic injuries with no remarkably malignant potential. The unquestionable contribution of the laparoscopic approach to these procedures has favoured this interesting therapeutical alternative even more.
Due to the high number of pancreatic pathologies that are treated in our Deparment, and despite the particular number of patients, it has been possible to gain a remarkable experience in the following techniques:
- Central pancreatectomy.
- Duodenal preserving cephalic pancreatectomy.
- Cephalic duodenopancreatectomy.
- Resection of the uncinate process.
- Neuroendocrine tumor enucleation.
- Partial gastrectomy for cystic dystrophia in the pancreas.
The use of this type of surgical procedure is justified in a particular number of patients if we consider the results in terms of surgical morbimortality, the decrease of postoperative pancreatic endocrine and exocrine failure, the decrease of surgical infections (splenic preservation in young patients) and the similar recurrence rates compared to radical techniques.
Cystic dystrophia in antral heterotopic pancreas.
Intraductal papilar mucinous neoplasm.
Mucinous cystic neoplasm located in pancreatic uncinate process.
Resection of the uncinate process.
Non-functioning neuroendocrine pancreatic tumor.