Longitudinal Pancreaticojejunostomy Research Articles

Pancreaticoduodenectomy combined with longitudinal pancreaticojejunostomy in the treatment of chronic pancreatitis: initial experience in 11 cases

Objective: To investigate the surgical strategy for chronic pancreatitis complicated with suspected malignant lesions in the pancreatic head and pancreatolithiasis in the distal pancreas. Methods: This is a retrospective cohort study. Clinical data from 11 patients with chronic pancreatitis who underwent pancreaticoduodenectomy combined with longitudinal pancreaticojejunostomy(PD-L) were retrospectively collected(PD-L group) from the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University between December 2021 and September 2023. All patients were male with an age of (49.0±11.2) years(range:32 to 70 years). Their primary preoperative diagnoses included pancreatic lesions, chronic pancreatitis, pancreatolithiasis, and dilatation of the pancreatic duct. Data from 248 patients who underwent pancreaticoduodenectomy(PD) during the same period were retrospectively collected(PD group). There were 157 males and 91 females in the PD group, with an age of (61.5±10.8) years(range:27 to 82 years). Among them, 87 cases were diagnosed as pancreatic cancer or chronic pancreatitis. The propensity score matching method was used to reduce confounding bias between the two groups. The caliper value of 0.1 was used and the 1∶4 nearest neighbor matching method was used for the matching. Comparisons between the two groups were made using the independent sample t test, Mann-Whitney U test or χ2 test,respectively. Results: After complete excision of the specimen during pancreaticoduodenectomy, the key surgical step of PD-L was longitudinal pancreaticojejunostomy in the remaining pancreas. Intraoperative blood loss in the PD-L group was lower than that in the PD group [M(IQR)](300(200)ml vs. 500(500)ml, respectively; P<0.05). Similarly, hospitalization days(21.0(7.0)days vs. 25.0(8.5)days) and postoperative hospitalization days(13.0(8.0)days vs. 17.0(5.0) days) were also lower in the PD-L group compared to the PD group (P<0.05). There were no significant differences in the operation time and postoperative complication rate between the two groups(P>0.05). In the PD-L group, the postoperative follow-up time was 5(5)months(range: 3 to 21 months). One case was lost for follow-up. Abdominal pain was relieved in 10 patients. Additionally, abdominal distension and steatosis were alleviated in 8 cases. Furthermore, 5 cases of diabetes mellitus showed improved control of HbA1c and fasting blood glucose levels after surgery. Conclusions: PD-L treatment can be used to treat chronic pancreatitis complicated by suspected malignant lesions in the pancreatic head and pancreatolithiasis in the distal pancreas. PD-L also has advantages in removing stones from the pancreatic duct and evaporation of pancreatic fluid. However, due to the single-center design and the small sample size of this study, further practice and long-term follow-up are still necessary.

Wirsungectomy for pancreatic hypertension in chronic pancreatitis

Background. Pain in chronic pancreatitis (CP) can occur as a consequence of mechanical factors— pancreatic ductal hypertension, interstitial pressure, inflammatory and neuropathic pathological changes in the pancreas. The purpose was to evaluate a novel modification of the classic Partington-Rochelle procedure via comparing functional results of conventional surgery group and wirsungectomy group. Materials and methods. A retrospective analysis of the case histories of patients with CP and an enlarged (≥4mm) main pancreatic duct was carried out for the period from 2003 to 2009, which underwent surgical treatment of CP. The SF-36 and EORTC QLQ-C30 questionnaires, and visual analogue scale of pain were used for the assessment. The first group included five patients with wirsungectomy with lateral pancreaticojejunostomy (PEA + WE); the second group consisted of 20 patients after the lateral pancreaticojejunostomy (PEA) only. Cross-tabulation analyses were performed to compare PEA and PEA + WE groups as well as those groups in different time points using a two-sided Student’s t-test. The significance level was set to p&lt;0.05. Results. The groups were compared in terms of VAS and the EORTC QLQ-C30 questionnaire before and 2 years after surgery using Student’s t-test for unrelated values: statistically significant differences between the groups according to VAS as before (p=0.757) and after surgery (p=0.696) were not obtained. There were no significant differences (p &gt; 0.05) between the PEA and PEA + WE groups before and after surgery according to the EORTC QLQ-C30 questionnaires, except for some items (p&lt;0.05) Within the groups according to VAS and EORTC QLQ-C30 (pain severity), in the PEA group (p=0.000001, p=0.000109) and the PEA + WE group (p=0.018, p=0.017) after surgery, there was a statistically significant decrease in pain. Conclusions. Longitudinal pancreaticojejunostomy with wirsungectomy is justified in patients with long-term CP, severe fibrosis of the pancreas with multiple calcifications of the periphery pancreatic ducts to decompress pancreatic ducts, and parenchyma. In the long-term period after 2 years, the proposed method of longitudinal pancreaticojejunostomy with wirsungectomy in patients with CP with dilation of main pancreatic duct according to the VAS scale and EORTC QLQ questionnaires C30 and SF-36 is accompanied by a significant reduction in pain.

Surgical drainage procedures for paediatric chronic pancreatitis: a scoping review.

Paediatric chronic pancreatitis (CP) is a relatively rare entity, but it can be accompanied by debilitating complications such as pseudocysts, chronic pain and pancreatic duct obstruction. Surgical drainage procedures, such as pancreaticojejunostomy or cystogastrostomy/jejunostomy to address these complications may be required; however, there is a paucity of evidence as to the efficacy and long-term outcomes of these operations in the paediatric population. A scoping review of contemporary (post-2000) studies detailing surgical pancreatic drainage procedures performed in children (< 18years) was undertaken. After screening, 24 case series detailing a total of 248 patients met the inclusion criteria. Longitudinal pancreaticojejunostomy and cystogastrostomy were the most common surgical procedures performed in children with CP and pseudocysts, respectively. Overall generally favourable outcomes were reported, but all studies were considered to have a high risk of bias. Operative management for paediatric CP is infrequently required; therefore, large prospective studies or trials focusing on this population are infeasible, limiting the best available evidence on the topic to case series, level IV. Recommendations to improve the quality of surgical care in the paediatric CP population could include centralisation and the formation of registries to allow accurate long-term follow-up.

Longitudinal Pancreatico-gastrostomy, A Quest for a Better Salvage for Chronic Pancreatitis in Bangladesh: An Outcome Analysis of Our Early Cases

Background: Chronic pancreatitis being one of the most distressing medical condition, is often complicated by common bile duct obstruction, fibrosis and acute inflammation of the pancreas. Pain, weight loss and diabetes are common in these patients. Surgery is the ultimate option after medical treatment fails to solve the distress. Longitudinal Pancreatico-jejunostomy is widely practiced all over the world as the option of choice. Pancreatico-gastrostomy is also being practiced by a few surgeons in a few centers. Here we practice Longitudinal Pancreaticogastrostomy (LPG) for chronic pancreatitis patients in our setup. This study was aimed to analyze the outcomes and privileges of LPG. Method: This prospective study was monitored and guided by the Department of Hepatobiliary and Pancreatic Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka over a period of 18 months. A total of 36 patients with chronic pancreatitis were allocated for Longitudinal Pancreatico-gastrostomy (LPG) surgery. Study tools included pain gradation, body weight, investigation profiles- serum lipase, blood sugar, USG of abdomen, CT Scan and MRCP. Duration of surgery, blood loss, hospital stay, assessment of post-operative pain relief and surgical complications were the parameters of the study. For pain relief assessment patients were divided into three categories, complete (no complaint pain), satisfactory (mild tolerable pain with normal daily activities) and unsatisfactory (moderate to severe pain requiring medication and hampered daily activities). Results: 36 patients in the group underwent LPG. Mean age in group was 22.94 ± 3.76 years. Majority of the patients had unknown etiology. The mean duration of illness in group was 4.27 ±0.96 years. LPG was easier to perform, took less time, less blood loss and hospital stay was short with less post-operative complications. Pain relief was satisfactory with most patients showing complete pain relief. Diabetes patients got much better glycemic control after surgery. Weight gaining was also significant. Conclusion: LPG is an easier and safer surgery which achieves good pain relief, glycemic control and nutritional improvements. Large volume studies should be done to establish its dominance against other surgical procedures. J Shaheed Suhrawardy Med Coll 2021; 13(1): 58-62

Outcome of Longitudinal Pancreatico-Jejunostomy on Pain Control and Pancreatic Function in Chronic Pancreatitis

Background: Outcome of drainage operation for chronic pancreatitis are variable. The present study is taken to observe effect of longitudinal pancreatico-jejunostomy (LPJ) on pain control and pancreatic function in chronic pancreatitis in our setting.Material &amp; Methods:Thirty-three patients who underwent LPJ for symptomatic chronic pancreatitis for one year period presented with abdominal pain (100%), steatorrhoea (30.3%), diabetes (66.7%) and weight loss (78.8%). Definitive diagnosis was made on the basis of ultrasonography and MRCP findings. LPJ (Partingtong-Rochelle) operation was done in all patients. Pain (using visual analoge scale), glycemic status (using FBS, 2hABF, HbA1c), body weight, serum zinc levels (as a marker of exocrine function), and serum insulin level (as a marker of endocrine function) were measured immediately after admission and 3 months after operation.Results:Three months after operation pain was completely disappeared in 23 (69.7%) patients, it persisted in different grade in 10 (30.3%) patients and the pain reduction rate was significant. Twenty two patients who had diabetes prior to surgery, their glycemic status significantly decreased and serum insulin level significantly increased (preoperative; 7.1±5.1 µU/L, postoperative; 14.3±4 µU/L) in 22 patients with DM after surgery. Serum zinc level increased (preoperative; 80.8±24.5 µg/dl, postoperative; 85.3±24.7 µg/dl) 3 months after surgery but the difference was not significant (p=0.571). However the body weight of all patients were significantly increased after operation.Conclusions:LPJ reduces abdominal pain and improves both exocrine and endocrine function in patient with chronic pancreatitis. Serum zinc levels can be considered as a tool of exocrine function.

Modern aspects of diagnosis and treatment of chronic pancreatitis in children: experience of the center Center for the treatment of developmental anomalies and diseases of the hepatopancreatobiliary system in children

Chronic pancreatitis is one of the most pressing problems of pediatric gastroenterology and surgery of hepatopancreatobiliary organs. Diagnosis and treatment of this category of patients requires a comprehensive examination using modern highly sensitive research methods and the collegial participation of a surgeon, gastroenterologist and endocrinologist. Due to the fact that the algorithm for managing these patients is not regulated, patients often receive enzyme replacement therapy for a long time, with indications for surgical treatment. In addition, the non-specificity of complaints and clinical manifestations of chronic pancreatitis, the asymptomatic course and the initial detection of exo- and endocrine insufficiency lead to a later choice of the optimal treatment method and increase the risk of complications. The key to effective care for children with chronic pancreatitis is the staging and continuity in research and treatment. At the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the Filatov Hospital, highly effective interventions are carried out for chronic pancreatitis in children, the purpose of which is to ensure an adequate outflow of pancreatic juice using longitudinal pancreaticojejunostomy, which, in addition to draining the pancreas, allows to achieve clinical remission and stop the progression pathological process, including diabetes mellitus. The article reflects the experience of diagnosis and treatment of chronic pancreatitis in children.

Генетически детерминированная сочетанная патология поджелудочной железы: муковисцидоз, панкреатит, диабет

In this article, we report a case of cystic fibrosis (CF) with untypical manifestations, including obstructive pancreatitis with relative pancreatic insufficiency, complicated by pancreatolithiasis and type 1 diabetes mellitus (DM1). Interestingly, the patient had almost none clinical manifestations of CF in the lower respiratory tract. The first manifestation was abdominal pain associated with chronic obstructive pancreatitis. The patient had only laboratory manifestations of DM1 without any clinical signs. DM1 treatment led to an increase in the child's body weight and increased external respiration, which allowed an operation for pancreatitis. We removed calculi and performed longitudinal pancreaticojejunostomy. The surgery alleviated pain and increased the external secretion of the pancreas. Thus, this case demonstrates difficulties associated with CF diagnosis, as well as effectiveness and feasibility of surgical treatment for obstructive pancreatitis, even in cases when it is believed to be an inherited and incurable disease. Key words: cystic fibrosis, pancreatitis, pancreatic insufficiency, pancreatolithiasis, type 1 diabetes mellitus

Pancreatic duct fluid culture in patients with chronic pancreatitis undergoing operative intervention and its implications on post operative course

Background: The role of bacteria in pathogenesis of chronic pancreatitis is poorly understood. Our aim was to analyse pancreatic duct fluid culture in patients undergoing operative intervention for chronic pancreatitis and its implications in post operative outcomes.Methods: Among 35 patients, 17 underwent Freys, 13 underwent longitudinal pancreatico-jejunostomy, 5 underwent cystojejunostomy. Duct fluid culture was obtained intraoperatively and analysed and compared with preoperative parameters and post operative outcomes.Results: 20 patients had positive duct fluid culture. Most common pathogen isolated was Klebsiella (8 patients). The only preoperative parameter which showed significant association was fasting blood glucose level. Wound infections were seen in 11 of which 10 had positive duct culture, out of which 9 had the same organism of that in duct culture. Mean hospital stay was 9±1.07 and 10±1.13 days in patients without and with infectious complications respectively.Conclusions: Older concept of sterile PD fluid in patients with CP may no longer hold true. In our study upto 60% of patients showed positive PD culture. By starting appropriate antibiotic we can reduce the length of hospital stay in patients who have septic complications. However large centre studies may guide us further into the importance of this concept and the role of bacteria in the pathogenesis of CP.

Longitudinal Pancreaticojejunostomy for Pancreaticodigestive Tract Anastomotic Stricture After Pancreaticoduodenectomy.

AimPancreaticodigestive tract anastomotic stricture is a long‐term complication of pancreticoduodenectomy (PD). However, optimal treatment has not yet been defined. We conducted longitudinal pancreaticojejunostomy (LPJ) in symptomatic patients with anastomotic stricture after PD. This study aimed to evaluate the efficacy of this procedure.MethodsPancreticoduodenectomy was performed in 605 patients at our institution between January 2005 and April 2020. Of these, 15 patients (2.5%) developed symptomatic pancreaticodigestive tract anastomotic stricture after PD. Three patients were referred to our institution owing to recurrent pancreatitis with anastomotic stricture after PD. LPJ was indicated for these 18 patients, and they were enrolled in this study.ResultsThe median time from the initial operation to LPJ was 2.0 y. Preoperative clinical presentations included obstructive pancreatitis in 10 patients, a rapid deterioration of glucose tolerance in nine, and severe steatorrhea in two. Surgical morbidity ≥grade III defined by the Clavien–Dindo classification was not observed. After LPJ, preoperative symptoms improved in 16 patients (89%) during a median follow‐up of 39 mo. Nine of the 10 patients with obstructive pancreatitis achieved complete pain relief. All nine patients with a rapid deterioration of glucose tolerance showed improved endocrine function. Daily insulin requirement was significantly decreased after LPJ (11.6 ± 3.3 vs 3.4 ± 4.3 units, P = .0239). Four of the seven patients who required insulin injections were free of insulin after LPJ.ConclusionLPJ is a safe and effective surgical procedure for symptomatic patients with stricture of the pancreaticodigestive tract anastomosis after PD.

ПРОКСИМАЛЬНАЯ РЕЗЕКЦИЯ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ С СОХРАНЕНИЕМ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ ПРИ ХРОНИЧЕСКОМ ПАНКРЕАТИТЕ

Aims/Objectives. The purpose of our research was studying of the reasons to increase head of the pancreas with a comparative estimation of morphological changes and outcomes of surgical treatment at patients by whom the local resection of the head of the pancreas with duodenum- preserving has been executed. Materials and methods. Results of the surgical treatment and morphological changes of 104 patients were studied: a local resection of the head of the pancreas with longitudinal pancreaticojejunostomy (LRHP+LPJ, n = 33), LRHP without LPJ (LRHP—LPJ' n = 36) and a local resection of the head and isthmus of the pancreas without LPJ (LRHIP—LPJ, n = 35). Results and discussion. In comparison groups has been revealed statistically significant distinction (Н = 17,357, df = 2, р = 0,002) on the sizes of the pancreas head. In their groups has been revealed statistically significant distinction in the sizes intrapancreatic pseudocysts in the pancreas head (Н = 8,912, df = 2, р = 0,012). The Spearman correlation (Spearman, p) had been found out statistically significant strong direct dependence between variables «the sizes of the pancreas head» and «the sizes intrapancreatic pseudocysts in the pancreas head «in comparison groups: LRHP+LPJ p = +0,73, р &lt; 0,0001, LRHP-LPJ p = +0,78, р &lt; 0,0001, LRHIP-LPJ p = +0,76, р &lt; 0,0001. Between three groups of the patients by quantity of complications after operation were statistically significant (x2 = 10,644, df = 2, р = 0,005). In comparison groups has not been established distinctions on presence of the complications with focal or diffuse perilobular fibrosis — С &lt; 0,200 or intralobular fibrosis — С &lt; 0,265, and presence periductal fibrosis — С = 0,124. Conclusions. The sizes of the pancreas' head in the compared groups directly depend on the sizes intrapancreatic pseudocysts in the pancreas head. The probability of the complications' development after operation is not depended with focal or diffuse perilobular fibrosis or intralobular fibrosis and presence periductal fibrosis.

慢性膵炎に対する膵管ドレナージ術における有病期間と手術成績の検討

慢性膵炎に対する膵管ドレナージ術における有病期間と手術成績の検討

Percutaneous single-operator video cholangioscopy using a novel short disposable endoscope: first clinical case with treatment of a complex biliary stone and inaccessible papilla after Roux-en-Y reconstructive surgery.

Percutaneous single-operator video cholangioscopy using a novel short disposable endoscope: first clinical case with treatment of a complex biliary stone and inaccessible papilla after Roux-en-Y reconstructive surgery.

New surgical technique for pancreatic lithotripsy without coring-out.

The Frey procedure, which involves longitudinal pancreaticojejunostomy with coring-out of the pancreatic head, is considered the ideal surgical procedure for chronic pancreatitis with pancreas head stone. Long-term relief from abdominal pain after the Frey procedure was reported to reach about 90%, and this is the most common surgical procedure for chronic pancreatitis in Japan. However, coring-out has the potential risk of severe complications such as bile duct injury, pancreatic fistula, and postoperative hemorrhage. Therefore, we introduce a new lithotripsy technique using laparoscopic coagulation shear without coring-out.

Surgical treatment for chronic pancreatitis: A single-center retrospective study in Japan.

To determine the short- and long-term results of surgical treatments for chronic pancreatitis (CP) at a high-volume center in Japan. The records of 151 consecutive patients undergoing surgery for CP were retrospectively reviewed. Selection of surgical procedures used had been according to the Japanese Clinical Practice Guidelines for CP 2015. Long-term (≥1year) follow-up was performed in 100 patients (median of 37months). Surgical drainage procedures were performed in 107 patients (Frey operation in 81, longitudinal pancreaticojejunostomy in 26), pancreatic resection in 37 (subtotal stomach-preserving pancreaticoduodenectomy in 11, distal pancreatectomy in 26), and other procedures in six. The rates of postoperative mortality and morbidity were 1% and 26%, respectively. The rates of complete and partial pain relief were 62% and 37%. The frequency of occurrence of severe morbidity was significantly higher after pancreatic resection than in patients receiving drainage procedures (13% vs 2%, P=.019). The rate of new-onset diabetes was also significantly higher after resection than drainage (60% vs 25%, P=.017). Surgical treatment for painful chronic pancreatitis can be safe and effective. An optimal procedure should guarantee pain relief and preserve a maximum of pancreatic function.

Open modified puestow procedure in an advanced endoscopic era for chronic pancreatitis with dilated pancreatic duct and stones

Background: Chronic pancreatitis has been defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphological changes. These changes typically cause pain and loss of exocrine and endocrine pancreatic function. The most common symptom of chronic pancreatitis is pain, which can be severe and intractable in some patients. Although it is itself benign, chronic pancreatitis can significantly affect quality of life and can cause significant distress with its complications [1]. The initial treatment for pain in most cases is to start of enzyme replacement, control of diabetes with insulin, and administration of oral analgesics. Surgical intervention is required in patients with intractable pain that is resistant to conventional nonsurgical therapy, in patients with associated or suspected malignancy, and in patients who have developed complications such as biliary or duodenal obstruction, pancreatic fistulae, pancreatic ascites/pleural effusion, pseudocyst, or rare hemosuccus pancreaticus [2]. The aetiology of pain in chronic pancreatitis is unclear. Some evidence has suggested that perineural inflammation may be the cause of pain. A dilated pancreatic duct, secondary to obstruction, may cause increased intraductal pressures, resulting in pain [3]. The primary aim of therapy is the achievement of primary pain relief and an improvement in quality of life. This could be achieved by means of endoscopic, open or laparoscopic /robotic lateral pancreaticojejunostomy [4, 13]. Methods: We selected 41 cases of chronic pancreatitis of both genders with moderate to intractable pain hampering routine life. All patients tried conservative treatment for more than 6 months. All selected patients underwent haematological and radiological work up. MRCP of all patients showing dilated pancreatic duct more than 7mm. in size. All of these patients operated for longitudinal pancreaticojejunostomy (Modified Puestow’s). Follow up done for one year to ten years Results: All 41 patients in long term follow up were recovered well from pain and abdominal discomfort. Appetite were improved and weight gain noted in the patients after surgery. Conclusions: Longitudinal pancreaticojejunostomy is still safe, simple and timely approved procedure for pain associated with chronic pancreatitis.

A case of triple digestive tract reconstruction in chronic pancreatitis complicated with bile ductal stenosis, duodenal stenosis, and portal vein stenosis: a case report

BackgroundAlthough endoscopic interventions for chronic pancreatitis are highly developed, surgery for severe complicated cases such as the coexistence of bile duct, duodenum, and portal vein stenosis is a challenging issue for surgeons. In such instances, pancreaticoduodenectomy could lead to massive intraoperative bleeding due to severe collateral veins. A surgical drainage procedure, instead of pancreatic resection, may be a reasonable and safer option in such cases, but the literature on a surgical drainage technique to resolve all obstructions of the pancreatic duct, bile duct, and duodenum at once is limited. We devised a new surgical drainage method for such cases with consideration for a possible future second surgery for newly developed pancreatic cancer because chronic pancreatitis is a well-known high-risk factor for pancreatic cancer in the long term. Here, we report this surgical procedure.Case presentationA 55-year-old man was diagnosed with alcoholic chronic pancreatitis 15 years ago. Before surgery, he underwent regular endoscopic pancreatic stenting for pancreatic ductal stenosis for 3 years. Three months before surgery, his duodenal stenosis worsened, and he was referred to our department for surgery. Preoperative imaging revealed pancreatic and bile duct stenosis, duodenal stenosis, and portal vein stenosis. To avoid intraoperative bleeding caused by the development of collateral veins, we performed a triple drainage procedure: longitudinal pancreaticojejunostomy with coring-out of the pancreatic head, hepaticojejunostomy, and gastrojejunostomy. The patient did not develop postoperative complications, and he was discharged from the hospital on postoperative day 14. For 5 years after surgery, no abdominal pain or recurrent pancreatitis was observed.ConclusionOur triple drainage procedure seems effective and minimally invasive for patients complicated with bile duct stenosis, duodenal stenosis, and portal vein stenosis.

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

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.

Experience with laparoscopic procedures in children with pancreatic pseudocysts

Introduction. Pancreatic pseudocysts are encapsulated fluid accumulations in the lesser sac, devoid of epithelial lining. Pseudocysts occur after traumatic or inflammatory injury of the pancreatic parenchyma and are relatively rare in children. In recent years, there has been a trend towards minimally invasive surgery for pancreatic pseudocyst. The article presents the experience of laparoscopic operations. Purpose to the study is to evaluate the effectiveness of laparoscopic operations in children with pancreatic pseudocysts. Materials and methods. There were 11 patients, range 4–17 years, from 2013 to 2018. An indication for surgery was the presence of a cystic cavity with a formed wall, more than 6 cm in size, which was not amenable to conservative management. In cases of infection of unformed pseudocyst, we conducted external drainage through the anterior abdominal wall and the gastrocolic ligament. Results. Surgical therapies for 11 patients consisted external drainage (2), laparoscopic Roux-en-Y cystojejunostomy (6), laparoscopic partial cystectomy with distal pancreaticojejunostomy (1), laparoscopic partial cystectomy with longitudinal pancreaticojejunostomy (2). We don’t have intraoperative complications. Early postoperative complications occurred in 2 patients: external pancreatic fistula in the place of drainage, which closed independently, and intestinal obstruction at the level of the Roux-en-Y anastomosis, which required reconstructive surgery. Conclusion . The type of intervention should be determined by the etiology of the cyst, localization and connection with the main pancreatic duct. Laparoscopic surgery in children with pancreatic pseudocysts is effective and less traumatic. Laparoscopy allows to conduct a full revision, to take material for histological examination, to perform, if necessary, sequestrectomy, to ensure reliable long-term drainage.

Outcome after Lateral Pancreaticojejunostomy for Chronic Calcific Pancreatitis: A Short Term Prospective Study

Chronic pancreatitis is a fairly common condition with pain being the major symptom and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess the outcome of LPJ for chronic calcific pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational study enrolling 28 patients was conducted in the department of surgery of Shaheed Suhrawardy Medical College Hospital from January 2018 to December 2018. This study involved identification of various risk factors related to chronic pancreatitis, pancreaticojejunostomy, early post-operative outcome and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief of pain in post-LPJ; the degree of relief was less in the alcoholics than non-alcoholics (p=0.09) and in smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. In chronic pancreatitis, there is a significant relief of pain in post-LPJ, although the degree of relief is less in the alcoholics and smokers.&#x0D; J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 13-16

Longitudinal pancreaticojejunostomy for paediatric chronic pancreatitis with dilated pancreatic ducts

Objective To analyze the results of longitudinal pancreaticojejunostomy in treatment of paediatric chronic pancreatitis with dilated pancreatic ducts. Methods A retrospective study was carried out on 13 patients with paediatric chronic pancreatitis complicated with dilated pancreatic ducts treated with longitudinal pancreaticojejunostomy in Children's Hospital of Chongqing Medical University from December 2011 to January 2017. The perioperative morbidity and mortality rates, long-term treatment results and postoperative growth of these children were analyzed. Results The 13 patients all underwent successful surgery. In 11 patients, the serum and urine amylase levels returned to normal after 8 days of operation, and the abdominal pain disappeared completely. In 1 patient, the abdominal pain gradually disappeared in 1 year, and the serum and urine amylase levels gradually returned to normal. This patient gained weight well. In the remaining patient who had severe pancreatic atrophy, the patient took high-fat diets before and after surgery, and drank alcohol occasionally. The patient developed repeated attacks of abdominal pain with occasional increase in serum and urine amylase levels and had poor weight gain. There were no complications such as postoperative bleeding, pancreatic leakage and intestinal obstruction in this study. The body weight and growth rates of the whole group of patients before and 1 year after surgery were different. Conclusion Longitudinal pancreaticojejunostomy for paediatric chronic pancreatitis complicated with dilated pancreatic ducts was safe and effective in alleviating symptoms, improving quality of life, and resulted in normal growth of these children. Key words: Pancreatitis, chronic; Pancreaticojejunostomy; Pancreatic duct dilatation; Treatment outcome