Shaheed procedure:-.New surgical technique in pancreatic calculi management.

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.

5.Bleeding  little.

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 .

6.Cases sporadic.

7.  suffering from severe abdominal pain that incapacitates  normal activities.

9.Non alcoholic.

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 .