Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):291-294. 10.14701/ahbps.2019.23.3.291.

Laparoscopic pancreatic neck transection and double pancreatico-jejunostomy, an alternative surgical approach to chronic pancreatitis

• Cruz CJ
• Kang I
• Lee WJ
• Kang CM

• KMID: 2456030
• DOI: http://doi.org/10.14701/ahbps.2019.23.3.291

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.

Keyword

Chronic pancreatitis; Pancreatico-jejunostomy

MeSH Terms

Abdominal Pain
Ampulla of Vater
Drainage
Female
Head
Humans
Mucous Membrane
Neck*
Pain, Intractable
Pancreas
Pancreatic Ducts
Pancreatitis, Chronic*
Sutures

Figure

• 

  Fig. 1 Abdominal CT-scan: section at the pancreas level revealing the uniformly dilated pancreatic duct with encrusted stone at the pancreatic head near the ampulla of Vater.

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  Fig. 2 Port placement and the position of the operating team (long: 12 mm, short: 5 mm).

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  Fig. 3 Surgical concept of pancreatic transection with double layer duct to mucosa endo-to-side double P–J procedure.

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  Fig. 4 Operation view after transection of the pancreatic neck. Note proximal pancreatic stump (pP) and the deviated distal stump (dP) with sufficient space to accommodate the jejunal loop (A), Distal stump P–J (B), Proximal stump P–J (C), and Completed double P–J (D). SV, splenic vein; SMV, superior mesenteric vein; J, jejunum, thick white arrow (pancreatic duct), thin white arrow (jejunotomy).

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