search for




 

Laparoscopic pancreatic neck transection and double pancreatico-jejunostomy, an alternative surgical approach to chronic pancreatitis
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):291-4
Published online August 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.3.291
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Charles Jimenez Cruz1,2,3, Incheon Kang2,3, Woo Jung Lee2,3, and Chang Moo Kang2,3

1Department of Surgery, Makati City Hospital, Makati City, Philippines, 2Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, 3Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
Received February 25, 2019; Revised April 27, 2019; Accepted April 30, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Chronic pancreatitis is a benign inflammatory process that results symptoms pertaining to loss of endocrine and exocrine function. Pain poses a great challenge in the management of CP and intractable pain represents the main indication for surgical intervention. Surgical options for CP ranges from pancreatic resection to pure drainage procedures. Herein, we present the case of 68 year-old female with recurrent abdominal pain due to chronic pancreatitis, who underwent successful laparoscopic pancreatic neck transection and double pancreatico-jejunostomy (duct-to-mucosa). Pre-operative imaging revealed a uniformly dilated pancreatic duct with encrusted pancreatic stone in the pancreatic head near the ampulla of Vater, with no inflammatory mass. Pre-operative laboratory work-ups were all normal. Pancreas texture was noted to be intermediate to soft. During pancreatic neck transection, there was spontaneous deviation of distal stump laterally leaving an ample space to accommodate jejunal loop. PD measured 8 mm. The standard duct to mucosa double layer simple interrupted suture was used for PJ anastomosis. There were no significant intra-operative events. No transfusion was required. Total operation time was 297 minutes, and it took 129 minutes for laparoscopic PJ completion. Immediate post-operative course was unremarkable. This case suggests laparoscopic double PJ can be an alternative surgical approach to reduce the pancreatic duct pressure in chronic pancreatitis. Based on accumulating experiences, long-term outcome also needs to be investigated to address potential role of this technique.
Keywords : Chronic pancreatitis; Pancreatico-jejunostomy

 

August 2019, 23 (3)