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 postoperative 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 (p0.054). 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.

Ki-67 proliferation index and clinicopathological patterns in colorectal carcinomas

“…Usual type adenocarcinoma was the most common histologic subtype in the present study and also in other studies. 7,13,14 In one study 7 mucinous carcinomas accounted for 11.6% of all cases and signet ring for 4%, almost similar to that in present study.…”

“…Majority of CRCs were grade 1 tumours (well differentiated) in the present study as was observed in another study 12 However, in several other studies 7,8,[14][15][16] CRCs were mostly grade 2 tumours (moderately differentiated).…”

“…In the present study there were no significant differences between male and female genders in terms of age, site affected, histopathological type and grade of tumours, although mucinous carcinoma and grade 3 tumours were relatively more common in males than females. In a study 14 right sided CRCs were more common in females compared to males in whom rectal cancers were more common. In the present study at all three subsites i.e., right colon, left colon and rectum, usual type adenocarcinoma was most com-mon.…”

A study on histopathological examination of colorectal carcinoma with special reference to expression of CK20 in colorectal adenocarcinoma at a tertiary care centre

“…In the present study, maximum cases were observed in the age group of 46-60 years (38.5%) which was also seen in studies by Halder et al 5 In a study by Virk et al, it was found that 70% of cases were of more than 65 years of age. 6 There is significant male preponderance in our study with the male to female ratio being 1.7:1, as similar to other studies by Laishram et al, Rasool et al and Haleshappa et al 8,9 In our study, on gross examination polypoidal type of growth was the most commonly found which is in accordance with study done by Peedikayil et al, and Ibrahim et al 10,11 CK20 expression was detected in 82.7% out of 52 cases of colorectal adenocarcinoma and negative in 17.3% cases.…”

Longitudinal Pancreatico-Jejunostomy Vs lateral Pancreatico-Gastrostomy as a Drainage Procedure for Pain Relieve in Chronic Pancreatitis Done in a Tertiary Referral Centre of Eastern India

“…For which, we wait for the next issue. While going through the last issue, we found an article titled 'Longitudinal pancreaticojejunostomy vs lateral pancreatico-gastrostomy as a drainage procedure for pain relief in chronic pancreatitis' [1]. As we also do lot of pancreatic work, we started reading with interest.…”