Laparoscopic Lateral Pancreatico-jejunostomy in Chronic Pancreatitis

Srikanth Gadiyaram, MCh, Neel Shetty, DNB, Ganesh Shenoy, MS, Sunil Alur, DNB. Institute of Gastroenterology, BGS Global Hospitals, Bangalore

 

Background: Laparoscopic lateral pancreatico-jejunostomy has been reported by few groups previously. We herein present our experience with laparoscopic management of chronic pancreatitis (CP).
Material and method: Retrospective review of patients who underwent laparoscopic management for chronic pancreatitis during April 2011 to June 2011 were studied from a prospective database The clinical profile, imaging charecteristics, operative details and postoperative outcomes were studied.
Results: Four patients ( 3 female and 1 male), age ranging from 20 to 46 yrs presented to the Department of Surgical Gastroenterology. All four patients presented with recurrent episodes of intermittent upper abdominal pain for 2-4 yrs duration. All 4 patients underwent basic biochemical evaluation and contrast-enhanced CT scan of abdomen. 3 patients had chronic calculous pancreatitis with duct dilatation of 15mm, and 1 had alcoholic chronic pancreatitis with large pseudocyst. Among the 3 chronic calculous pancreatitis patients 1 had already undergone an open pancreatico-jejunostomy previously.
Among the 4 CP patients, 3 chronic calculous pancreatitis patients underwent laparoscopic lateral pancreatico-jejunostomy and 1 alcoholic pancreatitis patient underwent laparoscopic cysto-jejunostomy. The median operating time in these patients was 280 minutes (range 250-360 minutes). The diameter of pancreatic duct in chronic calculous pancreatitis was 15 mm with stone load in head, body, tail and uncinate regions of pancreas. The average stay in the hospital was 6.6 days. A four- port technique was used, all surgeries were accomplished laparoscopically without any conversion to open surgery. Post-operatively all 4 patients faired well. There were 2 morbidities 1 had a low pancreatic fistula from the drain site which was managed conservatively and another had DVT which was managed appropriately by anticoagulation. There were no mortality. On follow-up all 4 patients had complete pain relief and all of them had weight gain.
Conclusion: Laparoscopic lateral pancreatico-jejunostomy is technically challenging but is feasible in CP patients with atrophic gland, large duct and no stone load in uncinate process. We demonstrated the feasibility of a re-do laparoscopic lateral pancreatico-jejunostomy in a carefully selected patient with previous failed open LPJ.


Session Number: Poster – Poster Presentations
Program Number: P355
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