Surgical Endoscopy

, Volume 28, Issue 8, pp 2499–2503 | Cite as

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

Video

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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

Disclosures

Dr. Manash Ranjan Sahoo and Dr. Anil Kumar have no conflicts of interest or financial ties to disclose.

Funding

None.

Supplementary material

464_2013_3330_MOESM1_ESM.m1v (228.2 mb)
Supplementary material 1 (M1 V 233636 kb)

References

  1. 1.
    Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W (1993) Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 54:148–155PubMedCrossRefGoogle Scholar
  2. 2.
    Evans JD, Wilson PG, Carver C, Bramhall SR, Buckels JA, Mayer AD et al (1997) Outcome of surgery for chronic pancreatitis. Br J Surg 84:624–629PubMedCrossRefGoogle Scholar
  3. 3.
    Bell RH Jr (2000) Surgical options in the patient with chronic pancreatitis. Curr Gastroenterol Rep 2:146–151PubMedCrossRefGoogle Scholar
  4. 4.
    Secknus R, Mossner J (2000) Changes in incidence and prevalence of acute and chronic pancreatitis in Germany. Chirurg 71:249–252PubMedGoogle Scholar
  5. 5.
    Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120:682–707PubMedCrossRefGoogle Scholar
  6. 6.
    Talamini G, Bassi C, Falconi M, Sartori N, Salvia R, Rigo L et al (1999) Alcohol and smoking as risk factors in chronic pancreatitis and pancreatic cancer. Dig Dis Sci 44:1303–1311PubMedCrossRefGoogle Scholar
  7. 7.
    Talamini G, Bassi C, Falconi M, Frulloni L, Di Francesco V, Vaona B et al (1996) Cigarette smoking an independent risk factor in alcoholic pancreatitis. Pancreas 12:131–137PubMedCrossRefGoogle Scholar
  8. 8.
    Maisonneuve P, Lowenfels AB, Mullhaupt B, Cavallini G, Lankisch PG, Andersen JR et al (2005) Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut 54:510–514PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Whitcomb DC (2000) Genetic predispositions to acute and chronic pancreatitis. Med Clin North Am 84:531–547PubMedCrossRefGoogle Scholar
  10. 10.
    Sarner M, Cotton PB (1984) Classification of pancreatitis. Gut 25:756–759PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Singh VV, Toskes PP (2003) Medical therapy for chronic pancreatitis pain. Curr Gastroenterol Rep 5:110–116PubMedCrossRefGoogle Scholar
  12. 12.
    Andren-Sandberg A, Hoem D, Gislason H (2002) Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol 14:957–970PubMedCrossRefGoogle Scholar
  13. 13.
    Karanjia ND, Singh SM, Widdison AL, Lutrin FJ, Reber HA (1992) Pancreatic ductal and interstitial pressure in cats with chronic pancreatitis. Dig Dis Sci 37:268–273PubMedCrossRefGoogle Scholar
  14. 14.
    Karanjia ND, Widdison AL, Leung F, Alvarez C, Lutrin FJ, Reber HA (1994) Compartment syndrome in experimental chronic obstructive pancreatitis: effect of decompressing the main pancreatic duct. Br J Surg 81:259–264PubMedCrossRefGoogle Scholar
  15. 15.
    Bradley EL (1982) Pancreatic duct pressure in chronic pancreatitis. Am J Surg 144:313–316PubMedCrossRefGoogle Scholar
  16. 16.
    Madsen P, Winkler K (1982) The intraductal pancreatic pressure in chronic obstructive pancreatitis. Scand J Gastroenterol 17:553–554PubMedCrossRefGoogle Scholar
  17. 17.
    Ebbehoj N, Svendsen LB, Madsen P (1984) Pancreatic tissue pressure: techniques and pathophysiologic aspects. Scand J Gastroenterol 19:1066–1068PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of SurgeryS.C.B. Medical CollegeCuttackIndia
  2. 2.Orissa Nursing HomeCuttackIndia

Personalised recommendations