Abstract

Research Article

Lateral Pancreato-Jejunostomy in Chronic Pancreatitis: An appraisal of 32 cases

Sardar Rezaul Islam*, Shafiqur Rahman, Shaurav Talukdar, Shah Alam Sarkar, Shah Poran and Mushfiqur Rahman

Published: 28 January, 2020 | Volume 4 - Issue 1 | Pages: 001-005.

Background: Lateral Pancreaticojejunostomy (LPJ) has recognized applications in the management of Chronic Pancreatitis (CP). It is done for patients with severe pain, obstructed and dilated pancreatic duct. Ductal obstruction by stone or stricture causes rise of intraductal pressure and parenchymal ischemia. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease. We want to share our experience of removal of stones and strictures from the pancreatic duct system and drainage of the main pancreatic duct by lateral pancreatojejunostomy (LPJ) for chronic pancreatitis in a teaching institute.

Methodology: We studied 32 cases of chronic pancreatitis operated between January 2010 and January 2017 for a period of 7 years. Patients were selected with ultrasonography, CT scan and or Magnetic Resonance Cholangio Pancreatography (MRCP). Dilatation of the main pancreatic duct by at least 7 mm proximal to the obstruction were recruited for operation. We did Roux-Y lateral pancreato-jejunostomy for patients with obstruction of the pancreatic duct due to intraductal stones or strictures. Additional distal pancreatectomy were done in two cases for stones and/or abscess in the tail area. We did one Frey’s operation for stone and fibro-calcification of the head. In all cases ductal drainage was accomplished by LPJ. We studied their post-operative pain control, complications, recurrence and improvement of exocrine and endocrine function of pancreas and mortality during this period. We followed these patients for about 2 years after surgery.

Results: We found 27 out of 32 patients got complete remission of the abdominal pain. Their progression of disease also slowed down. Ultrasonic evidence of chronic pancreatitis have improved or resolved. Ductal diameter have decreased. Two had recurrence of stones in the head and in the parenchyma within a year. 2 patients died during this follow-up period. One died three months after LPJ due to massive gangrene of the small intestine distal to LPJ and jejuno-jejunostomy and subsequent short bowel syndrome. Other one died of complications of diabetes and malabsorbtion. Pain free survival is about 84% and recurrence is 6%. Mortality during this follow up period is 6%.

Conclusion: We found that surgery, if done early, can have good remission of abdominal pain and can slow the progression of chronic pancreatitis and prevent further stone formation in majority of patients. Patient’s exocrine and endocrine function improves or remain static. Patient with chronic calcific pancreatitis and diabetes are unlikely to have favorable outcome even after decompressive surgery.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001043 Cite this Article Read Full Article PDF

Keywords:

Chronic pancreatitis; Pancreatic duct stone; Lateral pancreatojejunostomy

References

 

  1. Teemed B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001; 120: 682-707.
  2. Feldman M, Friedman LS, Brandt LJ. Slazenger and FORTRAN’s gastrointestinal and liver disease. 9th ed. Philadelphia, PA: Saunders Elsevier. 2010. 203-237.
  3. Amman RW, Munch R, Otto R, Buehler H, Freiburghaus AU, et al. Evolution and regression of pancreatic calcification in chronic pancreatitis: a prospective long-term study of 107 patients. Gastroenterology. 1988; 95: 1018–1028. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3410215
  4. Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engle J Med. 1995; 332: 1482–1490. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7739686
  5. Mitchell RM, Byrne MF, Baillie J. Pancreatitis. Lancet. 2003; 361: 1447–1455. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12727412
  6. O’Hara H, Hoshino M, Hayakawa T, Kamiya Y, Miyaji M, et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterology. 1996; 91: 1388–1394. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8678001
  7. Ebbehoj N, Burly L, Bulow J, Rasmussen SG, Madsen P. Evaluation of pancreatic tissue fluid pressure and pain in chronic pancreatitis: a longitudinal study. Scand J Gastroenterology. 1990; 25: 462–466. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2359973
  8. Kazanjian ND, Rebar HA. The cause and management of the pain of chronic pancreatitis. Gastroenterol Clin North Am. 1990; 19: 895–904. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2269524
  9. Koppel G. Pathology of chronic pancreatitis and pancreatic pain. Acta Chir Scand. 1990; 156: 261–265. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2349844
  10. Nealon WH, Townsend CM Jr, Thompson JC. Operative drainage of the pancreatic duct delays functional impairment in patients with chronic pancreatitis: a prospective analysis. Ann Surg. 1988; 208: 321–329. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3421756
  11. Greenlee HB, Print RA, Arana GV. Long-term results of side-to-side pancreaticojejunostomy. World J Surg. 1990; 14: 70–76. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2407040
  12. Adler DG, Lichtenstein D, Baron TH, Davila R, Egan JV, et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc. 2006; 63: 933–937. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16733106
  13. Sherman S, Lehman GA, Hawes RH, Ponich T, Miller LS, et al. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc. 1991; 37: 511–517. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1936826
  14. Adamek HE, Jakobs R, Buttmann A, Adamek MU, Schneider AR, et al. Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy. Gut. 1999; 45: 402–405. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10446109
  15. Delhaye M, Arvanitakis M, Verset G, Cremer M, Deviere J. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol. 2004; 2: 1096–1106. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15625655
  16. Rao KN, Van Thiel DH. Pancreatic stone protein: what is it and what does it do? Dig Dis Sci.1991; 36: 1505–1508. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19160596
  17. Tanaka T, Miura Y, Ichiba Y, Itoh H, Dohi K. Experimental pancreatolithiasis: association with chronic alcoholic pancreatitis. Am J Gastroenterol. 1992; 87: 1061-1071. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1642213
  18. Reddy DN, Surinam PV Das G, Rao GV. Endoscopic treatment of pancreatic disorder. Tropical Gastroenterol. 2001; 22: 149-154.
  19. Deviere J, Delhaye M, Cremer M. Pancreatic duct stones management. Gastrointestinal Endows Clin N Am. 1998; 8: 163-179.
  20. Lehman GA. Role of ERCP and other endoscopic modalities in chronic pancreatitis. Gastrointest Endosc. 2002; 56: 237-240. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12447274
  21. Guda NM, Freeman ML, Smith C. Role of extracorporeal shock wave lithotripsy in the treatment of pancreatic stones. Rev Gastroenterol Disord. 2005; 5: 73-81. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15976738
  22. Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, et al. Endoscopic vs Surgical drainage of pancreatic duct in Chronic pancreatitis. N Engl J Med. 2007; 356: 676-684. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17301298
  23. Rutter K, Ferlitsch A, Sautner T, Püspök A, Götzinger P, et al. Hospitalization, frequency of interventions, and quality of life after endoscopic, surgical, or conservative treatment in patients with chronic pancreatitis. World J Surg. 2010; 34: 2642-2647. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20645098
  24. Fang WL, Shyr YM, Su CH, Chen TH, Wu CW, et al. Long-term follow-up study of surgical treatment for pancreatic stones. Hepatogastroenterology. 2007; 54: 246-249. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17419270

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Figure 1

Figure 6

Figure 1

Figure 7

Similar Articles

  • Lateral Pancreato-Jejunostomy in Chronic Pancreatitis: An appraisal of 32 cases
    Sardar Rezaul Islam*, Shafiqur Rahman, Shaurav Talukdar, Shah Alam Sarkar, Shah Poran and Mushfiqur Rahman Sardar Rezaul Islam*,Shafiqur Rahman,Shaurav Talukdar,Shah Alam Sarkar,Shah Poran,Mushfiqur Rahman. Lateral Pancreato-Jejunostomy in Chronic Pancreatitis: An appraisal of 32 cases. . 2020 doi: 10.29328/journal.ascr.1001043; 4: 001-005.

Recently Viewed

Read More

Most Viewed

Read More