Lateral Pancreaticojejunostomy for Pain Relief in Chronic Pancreatitis: Analysis of Effectiveness in 19 Patients

Background: Surgery is the treatment of choice for intractable pain in chronic pancreatitis (CP). Drainage procedures are indicated in large duct disease whereas resectional procedures for small duct disease. Aim of this study was to assess prospectively the feasibility of drainage procedures in patients with CP with small duct disease.Methods: All consecutive patients with CP with small duct disease were included in the study. All patients underwent surgical intervention (lateral pancreaticojejunostomy with head coring). Primary outcome measures were pain relief and morbidity. These outcomes were compared with patients with CP with large duct disease.Results: 114 patients with CP underwent surgery. Of these 24(21.05%) patients had CP with small duct disease and 90(78.95%) patients had large duct disease. Demographic profile of the two groups was comparable. Mean pain scores were similar (47.75±6.85 versus 51.38±7.40; p = 0.14). Patients with large duct disease had higher incidence of diabetes mellitus (44.44% versus 8.33%; p = 0.02), but exocrine insufficiency was similar. All patients had calcifications in both the groups. Mean intraductal pressures measured intraoperatively were significantly high in patients with large duct disease (22.99±5.65 versus 18.33±3.52; p = 0.001). Frequency of complications at presentation were similar in both the groups (p = 0.29). Surgery relieved pain in 21/24 (87.5%) patients with small duct disease and 82/90 (91.11%) patients with large duct disease. Mean post-operative pain scores in small duct disease group (7.50±9.61 versus 51.38±7.40; p <0.001) and large duct disease group (5.14±7.88 versus 47.75±6.85; p <0.001) were significantly reduced when compared to preoperative pain scores. Incidence of postoperative complications was similar in both groups (16.66% versus 14.44%).Conclusions: Drainage procedures (lateral pancreaticojejunostomy with head coring) is a feasible for CP patients with small duct disease with good pain relief.

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A clinical study on lateral pancreaticojejunostomy in a case of chronic pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20211842 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1617

Author(s):

Suhas B. Manapure ◽

Anil S. Munde ◽

Ravibhushan J. Kasale ◽

Pramod Lokare

Keyword(s):

Quality Of Life ◽

Chronic Pancreatitis ◽

Pain Relief ◽

Pancreatic Duct ◽

Anastomotic Leak ◽

Pancreatic Insufficiency ◽

Drainage Procedure ◽

Health Care Centre ◽

Lateral Pancreaticojejunostomy

Lateral pancreaticojejunostomy is a seldom performed procedure in a peripheral tertiary health care centre. Very few numbers of cases are reported that undergoes surgical procedures for chronic pancreatitis. We report a such rare case in our institute that undergone pancreatic drainage procedure. A 70 year old poor patient was admitted in our institute with a complaint of chronic abdominal pain, subsequently diagnosed to be having chronic pancreatitis with complications with pancreatic duct calculus. Pancreatic drainage procedure, lateral pancreaticojejunostomy was performed and we analysed for the outcome of the procedure with regards to pain relief, anastomotic leak, quality of life and return to work. Patient recovered well post-operatively, reported pain relief, suffered no anastomotic leak and experienced improved quality of life. Lateral pancreaticojejunostomy provides excellent surgical choice for patients of chronic pancreatitis with pancreatic duct calculus with acceptable rates of pain relief, morbidity and mortality, without worsening pancreatic insufficiency.

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Faculty Opinions recommendation of Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718099073.793483257 ◽

2013 ◽

Author(s):

Walter Park

Keyword(s):

Chronic Pancreatitis ◽

Pain Relief ◽

Clinical Outcome ◽

Timing Of Surgery

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Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10122636 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2636

Author(s):

Ka Wing Ma ◽

Hoonsub So ◽

Euisoo Shin ◽

Janice Hoi Man Mok ◽

Kim Ho Kam Yuen ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pain Relief ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Endoscopic Drainage ◽

Complication Rates ◽

Surgical Drainage ◽

Endocrine Insufficiency ◽

Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

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