Surgical Management of Groove Pancreatitis: Lessons Learnt and Long-Term Experience

Abstract

Background: Groove pancreatitis (GP) is a rare form of focal chronic pancreatitis characterized by inflammation in the anatomic space between the duodenal wall and the head of the pancreas. This study aims to review the surgical experience in diagnosing and managing GP at a tertiary healthcare center in India.

Methods: A single-center, retrospective, cross-sectional study was conducted at the All India Institute of Medical Sciences, Jodhpur, between January 2017 and December 2023. The study included all patients with clinical, radiologic, and pathologic confirmation of GP. Data on demographics, clinical history, radiologic imaging, surgical intervention, and perioperative outcomes were collected. Pain and quality of life (QOL) were assessed preoperatively and postoperatively at 3, 6, and 12 months using the Izbicki pain score and the SF-36 questionnaire.

Results: During the study period, eleven patients with a clinico-radiologic diagnosis of GP underwent surgery. The median diagnostic delay was 14 months. Common presenting symptoms included abdominal pain (100%), gastric outlet obstruction (81.8%), and obstructive jaundice (18.2%). The majority of patients had a history of tobacco and alcohol abuse. Pancreato-duodenectomy (PD) was performed in ten cases, while one patient underwent a bypass procedure. Post-operative complications included post-operative pancreatic fistula (27.3%), delayed gastric emptying (54.5%), and post-pancreatectomy hemorrhage (9.1%). Three patients developed Clavien-Dindo IIIa complications. The median follow-up duration was 19 (IQR: 12-22) months. At the 12-month follow-up, pain and QOL scores showed significant improvement across all domains when compared to pre-operative measurements (p < 0.001). Three patients had recurrent pancreatitis due to resumption of alcohol and tobacco use.

Conclusion: GP is a rare and complex condition with significant challenges in diagnosis and management. Surgical treatment, particularly PD, provides effective symptom relief and improves QOL in most patients.

Keywords: Chronic pancreatitis; Groove pancreatitis; Pancreato-duodenectomy; Quality of life.