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Observational Study
. 2019 Jun 24;3(5):666-671.
doi: 10.1002/bjs5.50185. eCollection 2019 Oct.

Laparoscopic longitudinal pancreatojejunostomy and modified Frey's operation for chronic calcific pancreatitis

P Senthilnathan  1 , N Subrahmaneswara Babu  1 , A Vikram  1 , S C Sabnis  1 , S Srivatsan Gurumurthy  1 , N Anand Vijai  1 , V P Nalankilli  1 , C Palanivelu  1
Affiliations
Observational Study

Laparoscopic longitudinal pancreatojejunostomy and modified Frey's operation for chronic calcific pancreatitis

P Senthilnathan et al. BJS Open. .

Abstract

Background: Chronic pancreatitis is a debilitating disease presenting with pain, diabetes and steatorrhoea. Surgery offers better long-term pain relief than other interventions, but there is still uncertainty about the optimal surgical procedure and approach and a lack of long-term follow-up data in patients with chronic calcific pancreatitis selected for laparoscopic surgical treatment.

Methods: This was an observational cohort study of patients who underwent laparoscopic surgery for chronic calcific pancreatitis between January 2006 and April 2017, and had completed a minimum follow-up of 1 year at a tertiary-care teaching institute. Eligibility for the laparoscopic approach was main duct diameter greater than 7 mm, absence of extensive head calcification, size of head less than 3·5 cm, absence of local complications, and ASA grade I or II status. The primary outcome variable was a reduction in pain score by 1 year. Secondary outcomes were hospital stay, complications, pain score at 3 and 5 years, and the development or progression of exocrine and endocrine insufficiency.

Results: Some 57 patients were scheduled to undergo laparoscopic surgery for chronic pancreatitis: longitudinal pancreatojejunostomy (39), modified Frey's procedure (15) and pancreatoduodenectomy for suspicion of malignancy (3). The latter three patients were excluded from the analysis. Conversion to open surgery was needed in ten of the 57 patients (18 per cent). The mean(s.d.) age of the analysed cohort was 34·2(3·7) years and there was a predominance of men (34, 63 per cent). Adequate pain relief was achieved in 91, 89 and 88 per cent of patients at 1, 3 and 5 years of follow-up respectively.

Conclusion: Laparoscopic surgical management of chronic calcific pancreatitis with longitudinal pancreatojejunostomy or modified Frey's procedure is feasible, safe and effective in selected patients for the relief of pain.

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Figures

Figure 1
Figure 1
Port positionsA, Umbilical 13‐mm port; B, 10‐mm right‐hand working port; C, 5‐mm port for stomach retraction; D, 10‐mm left‐hand working port; E, 5‐mm left‐hand working port; F, epigastric port for liver and stomach retraction.
Figure 2
Figure 2
Identification of main pancreatic duct with needle aspiration
Figure 3
Figure 3
Extraction of stonesA, Pancreatic head; B, Posterior surface of main pancreatic duct; C, C loop of duodenum.
Figure 4
Figure 4
Head coringA, C loop of the duodenum; B, rim of pancreatic head; C, main pancreatic duct laid open.
Figure 5
Figure 5
PancreatojejunostomyA, Opened jejunum being anastomosed to main pancreatic duct; B, Opened pancreatic duct.
See this image and copyright information in PMC

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