Laparoscopic longitudinal pancreatojejunostomy and modified Frey's operation for chronic calcific pancreatitis

Abstract

BackgroundChronic pancreatitis is a debilitating disease presenting with pain, diabetes and steatorrhoea. Surgery offers better long‐term pain relief than other interventions, but there is still uncertainty about the optimal surgical procedure and approach and a lack of long‐term follow‐up data in patients with chronic calcific pancreatitis selected for laparoscopic surgical treatment.MethodsThis was an observational cohort study of patients who underwent laparoscopic surgery for chronic calcific pancreatitis between January 2006 and April 2017, and had completed a minimum follow‐up of 1 year at a tertiary‐care teaching institute. Eligibility for the laparoscopic approach was main duct diameter greater than 7 mm, absence of extensive head calcification, size of head less than 3·5 cm, absence of local complications, and ASA grade I or II status. The primary outcome variable was a reduction in pain score by 1 year. Secondary outcomes were hospital stay, complications, pain score at 3 and 5 years, and the development or progression of exocrine and endocrine insufficiency.ResultsSome 57 patients were scheduled to undergo laparoscopic surgery for chronic pancreatitis: longitudinal pancreatojejunostomy (39), modified Frey's procedure (15) and pancreatoduodenectomy for suspicion of malignancy (3). The latter three patients were excluded from the analysis. Conversion to open surgery was needed in ten of the 57 patients (18 per cent). The mean(s.d.) age of the analysed cohort was 34·2(3·7) years and there was a predominance of men (34, 63 per cent). Adequate pain relief was achieved in 91, 89 and 88 per cent of patients at 1, 3 and 5 years of follow‐up respectively.ConclusionLaparoscopic surgical management of chronic calcific pancreatitis with longitudinal pancreatojejunostomy or modified Frey's procedure is feasible, safe and effective in selected patients for the relief of pain.

Application of Clavien–Dindo classfication-grade in evaluating overall efficacy of laparoscopic pancreaticoduodenectomy

“…In northeastern China, table culture is a weighted means of communication, especially alcohol consumption, which is a main cause of chronic pancreatitis. Although the hard pancreas are almost universally accepted more likely to reduce the incidence of postoperative complications in terms of technique, some scholars (34,35) argue that the excessive fibrosis of the pancreas can affect the development of pancreatic anastomosis stoma, tending to leave gaps between the pancreas and jejunum in the process of stitching, and possible lacuna between pancreatic duct and supporting tube, which will be the hidden trouble to the patient outcome. It is also believed that men and women have different fat distribution and patients with more abdominal fat also have more fat in the pancreas, which affects the texture of the pancreas (36)(37)(38) and produce a certain impact on prognosis.…”

Changing trends in the minimally invasive surgery for chronic pancreatitis

“…Subsequently, a small series of four patients reported the feasibility and short-term outcomes of laparoscopic Frey’s procedure[ 89 ]. The largest published series to date had 15 patients in the laparoscopic Frey’s group[ 90 ]. The relatively small number of studies with fewer patients highlight the technical challenges of laparoscopic Frey’s procedure (Table 3 ).…”

“…In the absence of a definite landmark, pancreatic head coring until the level of the posterior pancreatic capsule is challenging during laparoscopic surgery. Hence, in all the laparoscopic series, only modified Frey’s procedure was performed using the main pancreatic duct as the landmark and coring to the posterior wall of the duct[ 88 - 90 ]. In the laparoscopic approach, ultrasonic shears and bipolar vessel sealing devices are commonly used for head coring.…”

“…In the laparoscopic approach, ultrasonic shears and bipolar vessel sealing devices are commonly used for head coring. Lack of articulation and difficulty securing precise hemostatic sutures further increase the difficulty of laparoscopic pancreatic head coring, especially along uncinate ducts[ 90 ]. With its articulating instruments, the robotic platform could potentially overcome technical difficulties during head coring and pancreaticojejunostomy.…”

Long-term outcomes of laparoscopic longitudinal pancreatojejunostomy and modified Frey’s procedure for patients of chronic pancreatitis: A 10-year experience

“…Chronic pancreatitis (CP) is a debilitating disease characterised by severe abdominal pain and progressive fibrosis of the pancreas, resulting in loss of exocrine and endocrine gland function. [ 1 ] Aetiological risk factors associated with CP are varied. Dietary factors such as micronutrient deficiency and genetic inheritance are thought to contribute to the higher incidence of ‘Tropical Pancreatitis’ in the Asian population.…”