Ann Surg Treat Res.  2020 Apr;98(4):190-198. 10.4174/astr.2020.98.4.190.

Drainage procedure for pancreatolithiasis: re-examination of the pancreatic duct diameter standard

• Chen G
• You Y
• Yan H
• He J
• Gong J
• Wei S

• KMID: 2500819
• DOI: http://doi.org/10.4174/astr.2020.98.4.190

Abstract

Purpose
Pancreatic duct decompression relieves pancreatic duct stone (PDS)-associated abdominal pain, though a consensus indication for the drainage procedure of the main pancreatic duct (MPD) is lacking. Moreover, major prognostic factors for postsurgical long-term pain relief and recurrence are largely unknown.
Methods
The clinical outcomes of 65 consecutive PDS patients undergoing surgery from 2008–2012 with 3+ years of follow-up were assessed.
Results
At postsurgical follow-up (median, 4.5 years; range, 3–7 years; procedure: Partington, n = 32; Frey, n = 27; pancreatoduodenectomy, n = 3; distal pancreatectomy, n = 3), the early complication and complete stone clearance rates were 29.2% and 97%, respectively. Long-term, complete and partial pain relief were 93.9%, 83.1%, and 10.8%, respectively. The risk of pancreatic fistula was higher in the <8 mm group than in the >8 mm group (P < 0.05), and 80% of the pancreatic fistula cases occurred in the <8 mm group. A shorter pain duration (P = 0.007), smaller MPD diameter (P = 0.04), and lower Izbicki pain score (P < 0.001) predicted long-term pain relief. Pain recurrence after initial remission occurred in 5 patients and was only related to pain duration (P = 0.02). Stone recurrence and pancreatic exocrine functional and endocrine functional deterioration occurred in 2, 5, and 11 patients, respectively.
Conclusion
Surgery provides excellent stone clearance, long-term pain relief, and acceptable postoperative morbidity. Using 8 mm as the criterion for drainage surgery can minimize the postoperative pancreatic fistula risk. Individualized and timely surgical treatment may improve the effect of surgery.

Keyword

Abdominal pain; Drainage; Operative surgical procedures; Pancreatitis; Prognosis

Figure

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  Fig. 1 Imaging tests of pancreatic duct stones evaluated by magnetic resonance cholangiopancreatography (A) and computed tomography (B). (A) Multiple stones are detected in the body and tail of the pancreas. (B) The main pancreatic duct is severely dilated; multiple stones are detected in the body and tail of the pancreas.

• 

  Fig. 2 Schematic diagram of the Partington surgery. (A, B) After longitudinal dissection of the pancreatic duct, scattered white calcified stones and pancreatic tissue fibrosis in the pancreatic duct were found. (C, D) The lateral anastomosis of pancreatic duct and jejunum. (E) Pancreatic duct stones removed from the pancreatic duct.

• 

  Fig. 3 Schematic diagram of Frey surgery. (A, B) The head of the pancreas was open and the stones were removed for decompression. (C, D) The anastomosis of pancreatic duct and jejunum. (E) Pancreatic duct stones removed from the pancreatic duct.

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  Fig. 4 Correlation between the main pancreatic duct diameter and pancreatic fistula incidence after the Partington or Frey operation. (A) The main pancreatic duct diameter in the group with (n = 10) or without pancreatic fistula (n = 49). (B) The incidence rate of pancreatic fistula in groups with different main pancreatic duct diameters. (C, D) The incidence rate of pancreatic fistula in groups according to different main pancreatic duct diameter criteria (7 mm or 8 mm) analyzed using the chi-square test. *P < 0.05. **P < 0.01.

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