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Celiac axis stenosis in pancreatic head resection for chronic pancreatitis
Jörn Pfeiffenberger1, Ulrich Adam, Oliver Drognitz
1Department of Surgery, St. Franziskus Hospital, Waldstrasse 17-21, 24939 Flensburg, Germany. pfeiffenberger@foni.net
Background And Aims:
To determine the outcome of pancreatic head resection for chronic pancreatitis in the presence of celiac axis stenosis or occlusion we analyzed the blood supply of the upper abdominal organs in 11 patients before and after surgery.
Patients And Methods:
Between March 1994 and April 2000 we performed 145 pancreatic head resections for chronic pancreatitis. Preoperatively 11 patients showed celiac axis stenosis at angiography. All 11 patients underwent duplex ultrasonography postoperatively and 8 had magnetic resonance angiography during follow-up.
Results:
In two cases division of the median arcuate ligament was performed to reestablish hepatic artery blood flow. No further revascularization procedures of the celiac axis were necessary. Postoperative duplex ultrasonography and magnetic resonance angiography showed normal blood flow in five patients. Four patients still had an occlusion or a significant celiac axis stenosis, and two had a stenosis only during expiration. At follow-up nine patients were completely free of abdominal pain (82%), and all had gained weight postoperatively, ranging from 5 to 16 kg.
Conclusions:
Our data suggest that celiac axis stenosis infrequently causes complications in pancreatic head resection for chronic pancreatitis and therefore does not represent a contraindication for this procedure. Nevertheless the hepatopedal blood flow must be confirmed by palpation or duplex ultrasonography after pancreatic head resection in these patients.