Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: systematic review of the literature

Abstract

Background: Patients with chronic pancreatitis (CP) may present severe and recurrent abdominal pain that limits their quality of life. Several studies have shown that surgery achieves greater long-term pain reduction than endoscopy in the treatment of obstructive CP, but it is also more cost-effective.Longitudinal pancreaticojejunostomy (LPJ), also known as modified Puestow or Partington-Rochelle procedure, is a surgical technique for the treatment of CP. It is usually performed by laparotomy, but it has been performed by laparoscopic or robot-assisted approach in a very small cases. Our aim is to clarify the current status of laparoscopic LPJ. Material & Methods: Adhering to the PRISMA guidelines, a systematic search about laparoscopic LPJ for the treatment of chronic pancreatitis without limits was performed. Results: Seventeen studies were included for critical appraisal: 8 case reports, 8 retrospective case series, and 1 case/control series without randomization. All of them had a grade of recommendation C and a level of evidence 4 according to CEBM.The patients were relatively young (median 37 years) and slight preponderance of males (ratio 1.3:1). Patients presented a long-standing pancreatic disease, endoscopic retrograde cholangiopancreatography before surgery and a dilated duct (11 mm).The surgery was usually performed by four trocars, the conversion rate was very low (5%), bleeding was minimal, the morbidity rate was 11% and there was no mortality. Mean hospital stay was 5.6 days. The follow-up period varied but was usually short, and the Results for pain control were very good since 90% of patients do not report pain (table I). Conclusions: Laparoscopic LPJ seems to be a safe, feasible and effective technique in patients with CP. Literature is scarce, and there are no studies with high scientific evidence comparing laparoscopic LPJ with open surgery or with endoscopic treatment that would allow us to draw firmer Conclusions at the present time. Tabled 1TABLE I: PUBLISHED ARTICLES ABOUT ON LAPAROSCOPIC LPJ. M: male, F female, CPY: years of chronic pancreatitis, LAP: Laparoscopy:, LLPJ: longitudinal la.