Laparoscopic surgery of the pancreas is still not fully developed. Several laparoscopic pancreatic procedures have been described. The most frequent is diagnostic laparoscopy for staging pancreatic neoplasm and, less frequently, treatment of pancreatic pseudocyst and resection of benign lesions of the pancreas. We report a laparoscopic modified Roux-en-Y pancreaticojejunostomy for chronic pancreatitis.
A 39-year-old man, ex-drug abuser with positive hepatitis C and HIV since 1987 was diagnosed of recurrent chronic pancreatitis in 1993 with 12 subsequent episodes of pancreatic reactivation. In 1998, ERCP was performed and pancreas divisum assessed, sphincterectomy performed and a pancreatic endoprosthesis inserted. This stent was patent for 4 years with the patient asymptomatic. In 2002 he presented another episode of pancreatitis due to stent obstruction which was removed by endoscopy; dilation of pancreatic duct in body and tail was observed with normal major papilla, bile duct and Wirsung duct. Owing to other episodes of mild pancreatitis, dilation of distal pancreatic duct observed on the last CTscan, surgical derivation was indicated.
A hand-sewn Roux-en-Y laparoscopic modified laterolateral pancreaticojejunostomy was performed. Surgery lasted 5 hours and 30 minutes. Postoperative period was uneventful and oral intake began on the 2nd postoperative day. Patient was discharged 6 days later. At 3-month follow-up, he remained well.
Therapeutic laparoscopy of the pancreas is still described as experimental by many surgeons. Appropriate pancreas cases are few and randomized trials difficult to perform to ascertain which patients would benefit from minimally invasive surgery. Laparoscopic pancreaticojejunostomy is a feasible but demanding laparoscopic procedure, but offers significant benefit to the patient: reduced trauma to the abdominal wall, short hospital stay and a rapid postoperative recovery.
Program Number: P308