Mario Masrur, MD, Jean Pierre Martucci, Md, Despoina Daskalaki, MD, Kristin Patton, MD, Shin Wang, MD, Francesco Bianco, MD, Pier Giulianotti, MD, FACS. University of Illinois at Chicago, Chicago, Illinois, USA.
Lateral pancreaticojejunostomy (LPJ), also known as Puestow procedure, has been the preferred surgical option for intractable abdominal pain in patients with chronic pancreatitis and dilated pancreatic duct. Very little has been reported in literature on minimally invasive approachs for this procedure. We present a case of chronic pancreatitis successfully treated with robotic-assisted Roux-en-Y lateral pancreaticojejunostomy.
Patient and Method
A 39 year-old male with history of alcoholism presented with chronic relapsing pancreatitis and intractable abdominal pain. Preoperative computed tomography of the abdomen showed features of chronic pancreatitis and dilated pancreatic duct with multiple strictures. After a diagnostic laparoscopy, a robotic-assisted LPJ was performed. The large pancreatic duct was identified with intraoperative ultrasound probe and a longitudinal ductotomy was performed. Subsequently, the first jejunal loops was transected and a jejunojejunostomy was completed. The Roux limb was brought up in a retrocolic fashion and a side-to-side pancreaticojejunostomy was achieved with running non-absorbable sutures, followed by interrupted reinforcing sutures.
The length of the operation was 180 min. Blood loss was minimal and the patient tolerated the procedure well with no intraoperative complications. He was discharged home on post-operative day six after an uneventful hospital course.
Robotic assisted lateral pancreaticojejunostomy is a feasible minimally invasive approach for patients with chronic pancreatitis and dilated pancreatic duct. The technical advantages of the robotic systems allow for precise suturing and careful hemostasis controlling in this difficult environment.