P Senthilnathan, Anand Vijai, V P Nalankilli, G Srivatsan, Sandeep Sabnis, R Parthasarathi, S Rajapandian, P Praveen Raj, C Palanivelu. GEM Hospital & Research Centre
Introduction: Chronic pancreatitis is managed using non-operative techniques with surgery limited only to selected patients. Modified Puestow and Frey’s procedures are frequently performed surgeries for chronic pancreatitis in tropical countries like India with prime aim to control the unremitting abdominal pain. Laparoscopic approach is a path less travelled as it is tedious. We present our long term experience in the laparoscopic management of chronic pancreatitis.
Methods: This is a review of prospectively maintained database from single center from 1998 till 2015. Indications for laparoscopic lateral pancreaticojejunostomy included patients presenting with unremitting abdominal pain along with dilated pancreatic duct obstructed by intraductal stones. Patients with predominant head disease underwent Frey’s procedure. The clinico-pathological data, operative variables and post-operative morbidity are analyzed. Patients were followed up at 1, 3, 6 and 12 months following the surgery.
Results: Forty seven patients underwent laparoscopic surgery for chronic calcific pancreatitis during this period with a mean age of 33.95 years (range 14-60) and female to male ratio of 1.94:1 (31vs16). The mean pancreatic duct diameter was 9.87mm. Thirty five patients underwent laparoscopic LPJ (Group A) and twelve underwent laparoscopic Freys procedure (Group B). Two patients from laparoscopic LPJ group and three from laparoscopic Freys group were converted to open in view of non-identification of pancreatic duct (n=2), extensive peri-pancreatic collaterals (n=1) and intra-operative hemorrhage (n=1). The other patient was intra-operatively diagnosed of carcinoma of head of pancreas by frozen biopsy and hence underwent open pylorus preserving pancreato-duodenectomy. The mean operative time was 237.35 minutes (214.7 minutes for group A and 260 minutes for group B) and mean blood loss was 200.7ml (168.7ml for group A and 232.7ml for group B). Post-operatively the patients were discharged after a mean hospital stay of 6.8 days. There were no major postoperative complications. Five patients lost to follow-up, 83.3% of the patients at follow up had significant pain relief at the end of 12 months while the remaining 16.7% experienced recurrence of pain.
Conclusions: Laparoscopic approach is safe, effective, and feasible for management of chronic pancreatitis with post-operative pain relief comparable to the open technique. It offers the advantages of minimal invasive surgery like i.e. shorter hospital stay; faster return to a regular diet, ambulation, and work; lower incisional hernia rates; as well as better cosmetic results. However it is applicable only in selected patients and requires surgeons highly experienced in open pancreatic surgeries and advanced laparoscopic gastro-intestinal surgeries.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80852
Program Number: P444
Presentation Session: Poster (Non CME)
Presentation Type: Poster