■ Do not cut corners; do the same operation every time regardless of the preoperative localization studies.
■ Develop a dedicated team approach; an ultrasonographer willing to take the time and effort to find the gastrinoma is crucial.
■ Beware of the ampulla and the pancreatic duct on the medial wall of the duodenum as these can feel like nodules and have been mistaken for a duodenal gastrinoma. I remove the gallbladder and pass a catheter through the cystic duct into the duodenum if there is any question about the location of ampulla. On occasion, I have given secretin intraoperatively to stimulate pancreatic secretion if there is a question that I may be identifying the pancreatic duct orifice.
■ Exclude MEN-1 preoperatively by screening for other endocrinopathies and questioning family history.
■ Remember that patients with both Zollinger-Ellison syndrome and MEN-1 generally have multiple pancreatic and duodenal neuroendocrine neoplasms, and thus cure-rate is very low. If a patient also has primary hyperparathyroidism, do the parathyroid operation first as this may ameliorate the manifestations of Zollinger-Ellison syndrome.
■ Be sure to continue the patient on an aggressive pharmacologic acid suppressive medication during the perioperative and postoperative period.
Was this article helpful?
For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.