A Comparative Study Between Longitudinal Pancreacticojejunostomy v/s Lateral Pancreaticogastrostomy as a Drainage Procedure for Pain Relief in Chronic Pancreatitis Done in a Tertiary Referral Centre of Eastern India

Abstract

Chronic pancreatitis (CP) is a chronic inflammation of pancreas that leads to progressive fibrosis of pancreatic parenchyma. Commonest indication of surgery in chronic pancreatitis is intractable pain. Choice of procedure depends upon the main pancreatic duct (MPD) morphology. Decompression is useful in dilated and obstructed ducts. Traditional form of decompression is construction of a pancreatico-jejunal anastomosis (LPJ). Another method to achieve ductal decompression is by a pancreaticogastrostomy (LPG) and this study will try to evaluate its effectiveness against pancreaticojejunostomy. To compare the effectiveness of LPG and LPJ in relieving intractable abdominal pain in patients with CP and their respective post-operative complications. This prospective study was done over a period of 4 years from Jan 2007 to Dec 2010 at IPGME & R (SSKM), a tertiary hospital of eastern India. Patients with diagnosis of CP with or without duct calculi and MPD diameter ≥7 mm with intractable pain were included. 70 patients were randomly allocated for LPJ and LPG operation by lottery method. Study tools were questionnaires, blood and radiological investigations and standard instruments for open surgery. The patients were prospectively analyzed for duration of surgery and hospital stay, operative/postoperative complications and assessment of postoperative pain relief. Pain relief was assessed as complete (no analgesic requirement), satisfactory (tolerable pain with normal daily activities) and unsatisfactory (hospitalization, narcotics or hampered daily activities). 1. Operative time was shorter in LPG than LPJ (Median 85 vs. 110 min). 2. Incidence of ileus was lesser in LPG group (p = .054). Other complications were comparable in both groups. 3. LPG was associated with shorter duration of hospital stay (Mean 6 vs. 8 days). 4. Pain relief was comparable in LPG and LPJ. LPG is a good alternative to LPJ for CP.