Denervated pancreatic flap for chronic pancreatitis pain - Warren's procedure

Degenerative pancreatic valve for chronic pancreatitis pain - Warren surgery for surgical treatment of chronic pancreatitis. In patients with refractory chronic pancreatitis pain and non-expanded pancreatic ducts, Warren designed a surgical approach to remove the majority of the pancreatic head and preserve the denervation to replace the 95% pancreatectomy to preserve the endocrine function of the pancreas. . Treatment of diseases: chronic pancreatitis Indication Degenerative Pancreatic Valve for Chronic Pancreatitis Pain - Warren Surgery Applies to: 1. Intractable chronic pancreatitis without pancreatic duct dilatation. 2. Pancreatic lesions are not limited to the pancreatic head. 3. Do not combine the lower end of the common bile duct or duodenal obstruction. 4. No diabetes. Contraindications 1. Mainly for pancreatic head lesions with common bile duct or duodenal obstruction. 2. Total pancreatic lesions, calcification, or existing diabetes. Preoperative preparation 1. Examination of vital organs such as heart, lung, liver and kidney. 2. Chest X-ray to exclude metastatic lesions. 3. Inject vitamin K to increase prothrombin activity. 4. Correct the electrolyte imbalances such as low potassium and low sodium. 5. For those who have obvious malnutrition due to too little food intake, intravenous nutrition is added 1 week before surgery to transfer whole blood and plasma to correct anemia and hypoproteinemia. 6. For patients with obstructive jaundice, oral bile salt preparations 1 week before surgery to reduce bacterial growth in the intestine. 7. Serve ranitidine 150mg before surgery to reduce stomach acid. 8. Apply prophylactic antibiotics. 9. Patients with serum bilirubin >171mol/L, the physical condition is still suitable for the operator, do not emphasize the routine use of preoperative transhepatic biliary drainage (PTBD) to reduce jaundice, if PTBD has been done, special attention should be paid to Electrolyte disorders caused by loss of bile, usually performed 2 to 3 weeks after drainage, to prevent biliary infection caused by PTBD. Percutaneous transhepatic gallbladder drainage can also achieve the same goal. In the case of the condition, it is feasible to introduce the drainage through the endoscope before the operation, and insert a thicker special built-in drainage tube through the common bile duct opening to the upper of the obstruction, so that the patient's condition can be improved quickly. 10. Place the gastrointestinal decompression tube before surgery. Surgical procedure 1. The oblique incision under the bilateral costal margins allows for good exposure to the left and right sides of the upper abdomen. 2. Separate the omentum from the upper edge of the transverse colon, pay attention to the preservation of the integrity of the vascular network on the omentum, because the left venous vein and the right venous venous connection of the gastric retina are important channels for spleen return after surgery. 3. Cut the peritoneum of the lower edge of the pancreas on the left side of the mesenteric vessel, free the lower edge of the pancreas, separate the dorsal pancreas from the superior mesenteric vein-portal vein, cut the pancreas in front of the superior mesenteric vein and properly ligature the hemorrhage on the pancreatic end. Same as typical pancreaticoduodenectomy. 4. Remove most of the head of the pancreas from the right side, preserve the vascular arch of the pancreaticoduodenal artery to maintain the blood supply of the duodenum, and avoid damage to the lower end of the common bile duct and the duodenal mesentery. Hemorrhage on the section of the pancreatic head must be sutured with silk thread to stop bleeding, and bleeding from the pancreatic section after surgery is a common complication. 5. The tail of the pancreas is retracted to the left side, and the splenic vein and the superior mesenteric vein are separated. The branch of the vein is generally small, so 2 non-invasive vascular clamps can be used for clamping and cutting. The ends were sutured with a 4-0 vessel line; the splenic artery was isolated at the upper edge of the pancreas and cut between the two ligatures. 6. Lift the tail of the pancreas together with the spleen and vein, and release it from the retroperitoneum. During this process, the posterior peritoneum and fibrous adipose tissue of the upper and lower margins of the pancreas are gradually clamped until the tail of the pancreas is connected with the spleen. The spleen can obtain blood supply from the short gastric artery. The spleen blood is returned to the left gastric vein through the upper venous spleen and venous network of the spleen and stomach. The gastric retinal vein arch is also an important reflux route. As the spleen and veins are severed, all accompanying nerve fibers are also cut off. 7. Gastrointestinal reconstruction is performed with a segment of Roux-en-Y jejunum fistula, jejunum fistula and the end of the pancreatic body with a closed end-to-end anastomosis or pancreatic duct jejunum anastomosis.

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