'Short' pancreaticojejunostomy might be a valid option for treatment of chronic pancreatitis in many cases

Abstract

Background: The Partington-Rochelle pancreaticojejunostomy (PJ) is an essential management option for patients with chronic pancreatitis (CP) associated with intractable pain and a dilated pancreatic duct (PD). Wide ductotomy and long PJ (L-PJ) have been advocated as the standard of care to ensure full PD decompression. However, the role of short PJ (S-PJ) in a uniformly dilated PD has not yet been evaluated.

Aim: To evaluate the possible advantages and disadvantages of S-PJ and L-PJ and to interpret the perspective of S-PJ in the treatment of CP.

Methods: A retrospective review of prospectively collected cohort data was conducted on surgically treated CP patients subjected to side-to-side PJ. The length of the PJ was adapted to anatomical alterations in PD. A comparison was made of S-PJ (< 50 mm) for uniformly dilated PD and L-PJ (50-100 mm) in the setting of multiple PD strictures, calcifications and dilatations. We hypothesized that S-PJ and L-PJ ensure comparable clinical outcomes. The primary outcomes were pain relief and quality of life (QOL); the secondary outcomes were perioperative characteristics, body weight, patients' satisfaction with treatment, and readmission rate due to CP.

Results: Overall, 91 patients underwent side-to-side PJ for CP, including S-PJ in 46 patients and L-PJ in 45 patients. S-PJ resulted in better perioperative outcomes: Significantly shorter operative time (107.5 min vs 134 min), lower need for intraoperative (0% vs 15.6%) and total (2.2% vs 31.1%) blood transfusions, and lower rate of perioperative complications (6.5% vs 17.8%). We noted no significant difference in pain relief, improvement in QOL, body weight gain, patients' satisfaction with surgical treatment, or readmission rate due to CP.

Conclusion: Based on our data, in the setting of a uniformly dilated PD, S-PJ provides adequate decompression of the PD. As the clinical outcomes following S-PJ are not inferior to those of L-PJ, S-PJ should be preferred as a surgical option in the case of a uniformly dilated PD.

Keywords: Chronic pancreatitis; Length of anastomosis; Pancreaticojejunostomy; Partington-Rochelle; Surgical treatment.

Figure 1

Two surgical options: ‘Short’ and ‘long’ ductotomy. A: ‘Short’ ductotomy (median length 40 mm), probing of the pancreatic duct; B: ‘Long’ ductotomy (length up to 100 mm). GDA: Gastroduodenal artery.

Figure 2

Box plot of the intensity of pain according to the numerical rating scale (0-10) before surgery and 1 yr after surgical treatment of chronic pancreatitis. NRS: Numerical rating scale; S-PJ: Short pancreaticojejunostomy; L-PJ: Long pancreaticojejunostomy.

Figure 3

Box plot of the pain disability index (0-70) before surgery and 1 yr after surgical treatment of chronic pancreatitis. PDI: Pain disability index; S-PJ: Short pancreaticojejunostomy; L-PJ: Long pancreaticojejunostomy.

Figure 4

Data on pain treatment before surgery and 1 yr after surgical treatment of chronic pancreatitis. Gray bars, opioid users; diamond-filled bars, users of non-opioid painkillers; white bars, non-users of any painkillers. S-PJ: Short pancreaticojejunostomy; L-PJ: Long pancreaticojejunostomy.

Figure 5

Quality of life RAND SF-36 mean scores, with 95% confidence interval, before surgery and 1 yr after surgical treatment of chronic pancreatitis. Black, short pancreaticojejunostomy (n = 46), gray, long pancreaticojejunostomy (n = 45); dashed lines, before surgery; solid lines, 1 yr after surgical treatment of chronic pancreatitis.