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Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique

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Abstract

Background

Chronic pancreatitis (CP) is a debilitating condition resulting in severe pain with progressive deterioration of pancreatic function. “Tropical” pancreatitis represents a variant of the disease with widely dilated ducts, numerous calculi, and few strictures. Traditionally, modified Puestow’s procedure has been the treatment of choice for a dilated pancreatic ductal system. However, it has only recently been adapted to laparoscopic approach which is a technically demanding procedure primarily due to need for extensive intra-corporeal suturing.

Methods

Symptomatic cases of CP presenting at our center with minimum 8 mm mean ductal diameter at body and head were selected for laparoscopic modified Puestow’s procedure. Those with prior pancreatic surgery, pancreatic head masses, endoscopic pancreatic stenting, and portal hypertension were excluded. Twenty-eight cases meeting selection criteria underwent a laparoscopic procedure.

Results

Seven patients (25%) underwent a stapled pancreaticojejunal anastomosis, 17 (60.7%) received a sutured anastomosis. Four patients (14.3%) were converted to open surgery due to failure to localize the pancreatic duct with percutaneous needle aspiration. Of those patients who underwent a successful laparoscopic procedure, a single patient developed a pancreatic fistula which resolved spontaneously; another patient had a difficult post-operative course with prolonged intensive care. We suffered no mortality within the series and no patient had any long-term disability. Anastomotic patency rates of 100% were achieved by the third post-operative month.

Conclusion

Lateral pancreaticojejunostomy is an effective surgical management for CP with a dilated ductal system. Its laparoscopic adoption is the rational next surgical step. It allows effective duct decompression with low mortality and morbidity. The procedure demands an advanced surgical skill set with an emphasis on intra-corporeal suturing. Those patients suffering from tropical CP with wide ductal dilatation greater than 12 mm are suited to an endostapled anastomosis which helps significantly reduce operative time without any corrosion of outcomes.

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Authors and Affiliations

  1. Department of General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, 6th floor, Hospital Building, Sir JJ Hospital Campus, Sir JJ Marg, Byculla, Mumbai, 400008, India

    Ajay Bhandarwar, Eham Arora, Saurabh Gandhi, Chintan Patel, Amol Wagh, Priyank Kothari & Shekhar Jadhav

  2. Department of General Surgery, Government Medical College, Nagpur, India

    Raj Gajbhiye

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  1. Ajay Bhandarwar
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Correspondence to Eham Arora.

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Dr. Ajay Bhandarwar, Dr. Eham Arora, Dr. Raj Gajbhiye, Dr. Saurabh Gandhi, Dr. Chintan Patel, Dr. Amol Wagh, Dr. Priyank Kothari, and Dr. Shekhar Jadhav have no conflicts of interest or financial ties to disclose.

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Bhandarwar, A., Arora, E., Gajbhiye, R. et al. Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique. Surg Endosc 33, 1749–1756 (2019). https://doi.org/10.1007/s00464-018-6434-3

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