Juan Toro, MD, Jesus Vasquez, MD, Carlos Lopera, MD, Sergio Diaz, MD, Jean Vergnaud, MD, Andres Ricardo. Surgery department, University of Antioquia School of medicine. Medellín, Colombia
BACKGROUND: Chronic pancreatitis (CP) is characterized by irreversible damage of pancreatic parenchyma leading to exocrine insufficiency, intractable pain and progressive loss of endocrine function. Lateral pancreaticojejunostomy (LPJ) is one of the most common procedures used for CP management, althougth there are very few reports of this procedure being done laparoscopically.
OBJECTIVE: To report the technique and results of laparoscopic LPJ in a CP case. Also, we review the literature about it.
METHODS: We show the case of a 24 years-old male with a 10 years length history of CP, chronic abdominal pain and dilated main pancreatic duct with a diameter of 34mm. Indications for surgery were intractable abdominal pain and weigth loss.
RESULTS: Randomized trials suggest thst surgical drainage of pancreatic duct in CP is more effective than endoscopic treatment. First laparoscopic LPJ was reported by Kurgan and Gagner in 1999. Largest reported series include 17 cases with an important follow-up period. In our case, we used a four-port technique, operative time was 180min and estimated blood loss was 50ml. There was not intraoperative accidents or conversion to open technique. Hospital length stay was 4 days. The only one complication was a port-related bleeding that required just medical management. There was not pancreatic fistula. Currently, the patient is asymptomatic and gaining weigth after a follow-up of 12 months.
CONCLUSION: LPJ is considered as the standard surgical procedure for CP. Laparoscopic LPJ is a technically demanding procedure although is safe and effective in experienced hands.
Program Number: P356