Shahidur Rahman, Professor. Bangobandhu sk.mujib medical university
1.Objective of the device:
Maximum pain free survival is motive.By new technique its possible.Applied in minimum Frey resection and Partingtons decompression technique without Roux-en- y anastomosis. Single anastomosis , lateral side to side pancreaticojejunostomy.
2.Description of the technology and method of its use or application.
Roof top incision abdomen opened. Upward pulling of transverse colon and mesocolon, pancreas felt at lowest part. Covered peritoneum incised along whole length . Pancreas visualized. Index and thumb used to palpate the pancreas and stone . Longitudinal incision given over the stone at antero-inferior surface(dependent part) , incision extended towards tail and head .Whole duct opened like book open. Widely dilated duct examined , contains multiple stones of various sizes, debris , thick fluid. Stones removed . Strictures checked , thick band , sheath incised. Duct made into single channel.At head inflammatory mass removed, send for histopathology. Duct opened towards head of pancreas right side of gastro- duodenal vessels. The stone at Wirsung and Santorini duct removed.
Jejunal loop selected 5-6 cm away from DJ flexure. Loop lies close proximity of pancreas. Selected loop hold using babcocks foreceps.Jejunum opened at anti-mesenteric border. Length about length of pancreatic duct . Anas-tomosis starts from tail, using 3-o silk of 2 pieces, proximal cut margin of jejunum fixed stitched to MPD margin.Lower margin of both duct and jejunum stitched by continuous suture proceeding towards head, some knot at definite space given for better anastomosis .Second suture from tail along upper margin ,continuous stitches given and proceed towards head .Keeping drain abdomen closed in 3 layers.
Merits:-1. Avoids roux –en- Y anastomosis
2. Single anastomosis, lateral pancreaticojejunostomy.
3.No hole at gastro-colic omentum , no chance of herniation .
4.Anastomosis made at antero-inferior surface , stagnation of any droplets of liquid digested food particles, secretion and juice of stomach , duodenum,liver, bile duct not happened. Enough space at anastomotic site, every contents easily moves by propulsive movements.
6.Morbidity , mortality zero.
3.Preliminary results :-
1.From Jan. 2010 to Dec. 2015 I had been doing this procedure in Bangladesh at different hospitals including Bangobandhu Sk. Mujib Medical university Dhaka, different private hospital of Dhaka city and at Satkhira district private hospital.
2. The total case 62.
3.Age ranges 15 yrs to 65yrs.
4. Female 35 and male 27.
5.Socioeconomic status poor .
7. suffering from severe abdominal pain that incapacitates normal activities.
10.None have complication i.e.,Pseudopancreatic cyst,biliary tree obstruction , and malignant tumour.
Patients under regular follow up. Communicated by mobile phone, some visits my office physically. Pain recurrence very few 3-4% . Slight attack of pain that controlled by drugs.
: New technique of pancreatic calculi management without Roux-en- y anastomosis. It gives best result about pain management.it is an extensive study and short time follow up.For long time follow up and multicentre study highly appreciated for the future direction. New procedure can be accepted by Hepatobiliary and pancreatic surgeon .