Modified Puestow procedure for the management of chronic pancreatitis in children

Abstract

PurposeTo present our experience with the modified Puestow procedure in the management of children with chronic pancreatitis. MethodsRetrospective chart review of patients treated between 2003 and 2012. ResultsSix patients underwent a modified Puestow procedure (lateral pancreaticojejunostomy) for the management of chronic pancreatitis, three females and three males. Four patients had hereditary pancreatitis (three with confirmed N34S mutation in the SPINK1 gene), one patient had chronic pancreatitis of unknown etiology, and one patient with annular pancreas developed obstructive chronic pancreatitis. The pancreatic duct was dilated in all cases, with a maximum diameter of 5 to 10mm. Median time between onset of pain and surgery was 4years (range: 1–9). Median age at surgery was 7.5years (range: 5–15). Median hospital stay was 12days (range: 9–28). Median follow up was 4.5years (range: 5months to 9years). All patients had temporary postoperative improvement of their abdominal pain. In two patients the pain recurred at 6months and 2years postoperatively and eventually required total pancreatectomy to treat intractable pain, 3 and 8years after surgery. Two patients were pain free for two years and subsequently developed occasional episodes of pain. The two most recent patients are pain free at 1year (obstructive chronic pancreatitis) and 5months (hereditary pancreatitis) follow-up. Two patients developed type I diabetes mellitus 10 and 12months postoperatively (one with hereditary and one with idiopathic chronic pancreatitis). ConclusionWe conclude that the modified Puestow procedure in children is feasible and safe. It seems to provide definitive pain control and prevent further damage to the pancreas in patients with obstructive chronic pancreatitis. However, in patients with hereditary pancreatitis, pain control outcomes are variable and the operation may not abrogate the progression of disease to pancreatic insufficiency.