Laparoscopic longitudinal pancreaticojejunostomy using cystoscope and endoscopic basket for clearance of head and tail stones

Abstract

Aim

Our aim was to study the results of laparoscopic pancreaticojejunostomy using cystoscope and endoscopic basket for clearance of stones in both the head and tail region.

Materials and methods

Twelve patients with chronic pancreatitis (CP) underwent laparoscopic longitudinal pancreaticojejunostomy (LPJ) in our unit. Patients’ ages ranged between 19 and 45 years. The most common presenting symptoms were abdominal pain and weight loss. In all patients, diagnosis was confirmed by magnetic resonance cholangiopancreatography. Mean pancreatic duct diameter was 14.8 mm and we used a four-port technique. The pancreatic duct was identified by clearing the peripancreatic fat, palpating with a blunt instrument, and by aspirating pancreatic juice using a thin lumbar puncture needle. Clearance of the pancreatic duct in the head region was confirmed by direct vision using cystoscope introduced through the left lateral port, and the tail region through the right lateral port. After clearance of all stones, the leftover stones were removed using endoscopic basket through the cystoscope. We routinely perform side-to-side pancreaticojejunostomy using 1-0 polypropylene suture reinforced with 1-0 Mersilk. All 12 patients who underwent laparoscopic LPJ had anteroposterior dimension of the pancreatic head of not more than 3 cm without any pancreatic head parenchymal calcification and with minimal stone load in the head, hence head coring was not contemplated.

Results

Mean operating time was 262.5 min and mean postoperative stay was 5.8 days. There were no conversions, or intraoperative and major postoperative complications. Mean duration of follow-up was 16.5 months. Our first eight patients who were having more than 12 months’ follow-up had pain relief and significant weight gain.

Conclusion

Laparoscopic LPJ is a safe, effective, and feasible technique for CP in selected patients in the presence of adequately dilated pancreatic duct containing stones, and has favorable outcome in short-term follow-up.