Pancreaticogastrostomy: The preferred operation for pain relief in chronic pancreatitis

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.

show abstract

“…[1] Abstinence from alcohol is probably the single greatest contributory factor in positive results of surgery [2].…”

Section: Discussionmentioning

confidence: 99%

“…Recently uncontrolled studies show LPG is better as drainage procedure in chronic alcoholic pancreatitis though the technique of operation is not always identical [2,10].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The initial search strategy retrieved 1,168 articles by July 1st, 2011; after screening all titles, abstracts, and texts, overall 49 full-text articles were identified, 23 of which [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34] were excluded due to various reasons shown in Appendix 1. Thus, 26 full articles were retrieved for further detailed evaluation.…”

Section: Resultsmentioning

confidence: 99%

Pancreaticojejunostomy versus Pancreaticogastrostomy after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

He¹,

Zhao

Chen³

et al. 2013

Dig Surg

View full text Add to dashboard Cite

Background and Objectives: The method of pancreatic reconstruction after pancreaticoduodenectomy (PD) is closely associated with postoperative morbidity, mortality, and patient's quality of life. The objective of this study is to evaluate which anastomosis approach - pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is a better option of choice in terms of postoperative complications. Methods: Articles comparing PG and PJ that were published by July 2011 were retrieved and subjected to a systematic review and meta-analysis. Results: Four randomized controlled trials (RCTs) and 22 observational clinical studies (OCSs) were included. RCTs showed that the PG group had significantly lower incidence rates of postoperative intra-abdominal fluid collection (p = 0.003, relative risk (RR) 0.50, 95% CI 0.31-0.79) and multiple intra-abdominal complications (p = 0.0007, RR 0.26, 95% CI 0.12-0.56) than the PJ group. OCSs demonstrated significant differences between PG and PJ in terms of frequencies of postoperative biliary fistula, intra-abdominal fluid collection, pancreatic fistula, morbidity, and mortality. The overall analysis revealed significant differences in frequencies of intra-luminal hemorrhage (p = 0.03, OR 2.82, 95% CI 1.08-7.33) and grade B/C pancreatic fistula (p = 0.002, OR 0.42, 95% CI 0.24-0.73) between the two groups. Conclusions: Current literature has no adequate evidence to prove that PG is superior to PJ for patients undergoing PD in terms of postoperative complications. A standardized classification of pancreatic fistula and other intra-abdominal complications may enable an objective, valid comparison between PG and PJ.

show abstract

“…[16,17]. However, a number of reports indicate that the incidence of pain relief deteriorates with time so that pain relief is reduced to less than 50% of patients at 3-5 years [18,19], Surgeons differ on the size of the major pancreatic duct they are willing to decompress. Those surgeons who sew to the capsule of the pancreas rather than the duct to mucosa will be able to decompress ducts as small as 3 mm in diameter.…”

Section: The Surgical O Ptions and Resultsmentioning

confidence: 99%

Local Resection of the Head of the Pancreas Combined with Longitudinal Pancreaticojejunostomy: Rationale and Results in Patients with Chronic Pancreatitis

Ho¹,

Frey²

1996

Dig Surg

View full text Add to dashboard Cite

Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy is an effective surgical procedure for patients with chronic pancreatitis. It is simple to perform, and carries low risk. It requires no division of the pancreas or resection of the uncinate process. It completely decompresses all ductal systems and does not result in significant compromise of endocrine and exocrine function of the pancreas. Pain relief was obtained in 88% of patients with chronic pancreatitis after the procedure. Its results compare favorably with other available surgical options for chronic pancreatitis.

show abstract

Pancreaticogastrostomy: The preferred operation for pain relief in chronic pancreatitis

Cited by 39 publications

References 25 publications

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

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

Pancreaticojejunostomy versus Pancreaticogastrostomy after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

Local Resection of the Head of the Pancreas Combined with Longitudinal Pancreaticojejunostomy: Rationale and Results in Patients with Chronic Pancreatitis

Contact Info

Product

Resources

About