Tamil Nadu - Chennai

Meet on surgery focuses on exchange of ideas

Staff Reporter

Doctors face dilemma while treating those with chronic pancreatitis Endoscopy or stent placements in pancreatic duct are short-term relief measures

CHENNAI: As a surgeon, what should you do when you come across a disease whose exact cause is not known, that strikes at a young age and advances insidiously?

"Often, the clinical features of chronic pancreatitis are mistaken for malignancy," said Manohar Joshi, president, Indian section of International College of Surgeons (ICS), as he singled out an important dilemma that surgeons tackling this condition were faced with.

Dr. Joshi was addressing a gathering of around 200 delegates, including young surgeons and post-graduate students, and 75 faculty members attending a surgery update organised by ICS last week.

Chronic pancreatitis is often associated with prolonged alcohol abuse but otherwise the exact cause cannot be determined. Conditions such as hyperparathyroidism (excessive release of hormones by the parathyroid gland), injury and chronic obstruction of the pancreatic duct can also be associated with chronic pancreatitis.

In such conditions, inflammation and fibrosis ruin glandular tissue interfering with enzyme release to digest fat. The disruption of insulin production can lead to diabetes.

Bypass from pancreas

Dr. Joshi pointed out when the pancreas is dilatated, creating a bypass from the pancreas to the small intestine relieves pain in a majority of patients.

However, when the duct is not dilatated, part of the pancreas would have to be removed resulting in loss of cells producing insulin and opening the door for diabetes.

Alternative interventions such as endoscopy or stent placement in pancreatic duct are at best short-term relief measures.

The experience with lithotripsy too had not been encouraging as it only resulting in breaking down the bigger stones, which interfered with the stenting, Dr. Joshi said.

He outlined as treatment objectives, relieving the obstructing agents, overcoming stagnation of secretions and freely draining the gland.

Inaugurating the event, Kalavathy Ponniraivan, Dean, Madras Medical College, called for a coordinated attempt among specialist doctors to put in place a day care surgery facility at General Hospital, where an interdisciplinary team of experts reviewed patients, gave appropriate treatment and discharged them the same evening. Such a facility would not only bring down hospital stay and associated costs but also extend the benefits of multidisciplinary consultation to the common man.

K. Dakshinamoorthy, organising chairman, said the ICS was representative of general surgeons and surgeons of different specialities.

The update, an annual fixture, was to provide a common platform for general and specialised surgeons.

G. Sivakumar, convenor, said the event promoted interdisciplinary collaboration, exchange of information and ideas.

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