14.03.11 Placement notes

Angelchick prosthesis

  • Large silastic 'C'-shaped ring that can secured around the oesophago-gastric junction

  • Previously used for GORD

  • Not used any more due to risk of stenosis + obstruction

Pancreatic pseudocyst

    • Circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue

    • Lined with granulation tissue (not epithelium)

    • Typically located in the lesser sac of the abdomen

    • Causes: Pancreatitis, Abdominal trauma]

    • Sequalae of acute pancreatic collection

    • => More organized over several weeks => Walled-off within thick wall of granulation tissue and fibrosis

    • Investigations:

      • USS (but may be obscured by gas-filled stomach)

      • CT (gold standard)

      • MRCP (to establish relationship of the pseudocyst to the pancreatic ducts)

    • Management:

    • Connection is created between the cyst and an adjacent intestinal organ

    • e.g. Cystogastrostomy/Cystjejunostomy (body or tail of pancreas), Cystduodenostomy (head of pancreas)

    • Complications

    • Infection, haemorrhage, obstruction, rupture


  • AKA Pancreaticoduodenectomy, Pancreatoduodenectomy

  • Paliative procedure (occasionally curative)

    • For Ca head of the pancreas, CBD, duodenal papilla, duodenum near the pancreas, and/or pancreatitis with or without definitive cause

    • Removal of the distal half of the stomach, gall bladder and its cystic duct, CBD, head of pancreas, duodenum, proximal jejunum, and regional lymph nodes

    • Reconstruction: Pancreaticojejunostomy and hepaticojejunostomy


    • Picolax

      • = Sodium picosulphate (stimulant laxative, activated by bacteria in colon) with magnesium citrate (osmotic laxative)

      • Bowel-prep, NOT for constipation

      • Take 2 sachets on the day before procedure

    • Laxido

      • = Macrogol (PEG)

      • For long-standing constipation / faecal impaction