4.4 Article

The in situ near-total pancreatectomy (LIVOCADO procedure) for end-staged chronic pancreatitis

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LANGENBECKS ARCHIVES OF SURGERY
卷 406, 期 8, 页码 2657-2668

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SPRINGER
DOI: 10.1007/s00423-021-02107-x

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Surgery; Extra-hepatic portal hypertension; Pain; Varices; Beger operation; Frey operation

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  1. Projekt DEAL

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The Livocado procedure is a safe and successful option for patients with chronic pancreatitis complicated by vascular involvement. Post-operative pain scores significantly improved, with two-thirds of patients being completely pain-free at 12 months, and employment rehabilitation rates also increased significantly.
Purpose Total pancreatectomy for severe pain in end-stage chronic pancreatitis may be the only option, but with vascular involvement, this is usually too high risk and/or technically not feasible. The purpose of the study was to present the clinical outcomes of a novel procedure in severe chronic pancreatitis complicated by uncontrollable pain and vascular involvement. Methods We describe an in situ near-total pancreatectomy that avoids peripancreatic vascular dissection (Livocado procedure) and report on surgical and clinical outcomes. Results The Livocado procedure was carried out on 18 (3.9%) of 465 patients undergoing surgery for chronic pancreatitis. There were 13 men and 5 women with a median (IQR) age of 48.5 (42.4-57) years and weight of 60.7 (58.0-75.0) kg. All had severe pain and vascular involvement; 17 had pancreatic parenchymal calcification; the median (IQR) oral morphine equivalent dose requirement was 86 (33-195) mg/day. The median (IQR) maximal pain scores were 9 (9-10); the average pain score was 6 (IQR 4-7). There was no peri-operative or 90-day mortality. At a median (IQR) follow-up of 32.5 (21-45.75) months, both maximal and average pain scores were significantly improved post-operatively, and at 12 months, two-thirds of patients were completely pain free. Six (33%) patients had employment pre-operatively versus 13 (72%) post-operatively (p = 0.01). Conclusions The Livocado procedure was safe and carried out successfully in patients with chronic pancreatitis with vascular involvement where other procedures would be contraindicated. Perioperative outcomes, post-operative pain scores, and employment rehabilitation were comparable with other procedures carried out in patients without vascular involvement.

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