Robotic lateral pancreaticojejunostomy (Puestow procedure) performed for chronic pancreatitis

ASVIDE ◽  
2018 ◽  
Vol 5 ◽  
pp. 394-394
Author(s):  
Adeel S. Khan ◽  
Imran Siddiqui ◽  
Dionisios Vrochides ◽  
John B. Martinie
Keyword(s):  
Chronic Pancreatitis ◽  
Lateral Pancreaticojejunostomy ◽  
Puestow Procedure

Puestow Procedure for the Management of Pediatric Chronic Pancreatitis

2017 ◽  
Vol 29 (02) ◽  
pp. 153-158 ◽  
Author(s):  
Erica Hodgman ◽  
Steve Megison ◽  
Joseph Murphy
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pancreatic Head ◽  
Childhood Development ◽  
Drug Induced ◽  
Lateral Pancreaticojejunostomy ◽  
Pancreatic Duct Stenting ◽  
Puestow Procedure ◽  
Pain Symptoms

Objective Recurrent pancreatitis significantly impacts childhood development and quality of life. Our goal was to evaluate the efficacy of the Puestow procedure. Materials and Methods After obtaining the Institutional Review Board approval, we reviewed the charts of all patients who underwent lateral pancreaticojejunostomy from January 1999 to January 2014. Statistical analysis was performed using paired Student's t-test and Fisher's exact test as appropriate. Results During the 15-year study period, 13 patients underwent a lateral pancreaticojejunostomy for chronic pancreatitis. The most common causes of pancreatitis were hereditary (n = 5) or obstructive (n = 5); pancreas divisum (n = 2), one iatrogenic stricture, one idiopathic stricture, and one unresectable pancreatic head mass); two patients had idiopathic disease, and one case was drug-induced. Six patients had failed management with endoscopic retrograde cholangiopancreatography and pancreatic duct stenting. Preoperatively, the median body mass index (BMI) percentile-for-age was 61.0% (range 11.0–99.0%). Median age at operation was 12.8 years (range 7.7–16.7). There were no deaths, four patients developed postoperative ileus, and one patient developed an intra-abdominal abscess, which resolved with antibiotics. Median postoperative length of stay was 7 days (range 5–15).Two patients were lost to follow-up; median follow-up for the remaining 12 patients was 35.5 months (range 4.9–131.2). Four patients were readmitted within 90 days: three due to abdominal pain which were not recurrences of pancreatitis, and one due to complications of chemotherapy. Postoperatively, there was no change in the average BMI percentile-for-age (p = 0.64). Seven patients reported resolution or significant improvement in their abdominal pain symptoms at the time of last follow-up. Patients with obstructive causes of pancreatitis were not more likely to experience relief than those with nonobstructive causes (42.9 vs. 80.0%, p = 0.29). Conclusion In our experience, lateral pancreaticojejunostomy results in durable improvement or resolution of abdominal pain symptoms in nearly 60% of patients with chronic pancreatitis regardless of etiology.

Narcotic Independence After Pancreatic Duct Stenting Predicts Narcotic Independence After Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Pancreas ◽  
2016 ◽  
Vol 45 (8) ◽  
pp. 1126-1130 ◽  
Author(s):  
Richard S. Kwon ◽  
Benjamin E. Young ◽  
William F. Marsteller ◽  
Christopher Lawrence ◽  
Bechien U. Wu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Pancreatic Duct Stenting

scholarly journals Drainage procedures for small duct disease in chronic pancreatitis: a feasible option

2018 ◽  
Vol 5 (6) ◽  
pp. 2319
Author(s):  
Venkatarami Reddy Vutukuru ◽  
Raghavendra Rao R. V. ◽  
Varughese Mathai ◽  
Sarala Settipalli
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Intractable Pain ◽  
Disease Group ◽  
Preoperative Pain ◽  
Exocrine Insufficiency ◽  
Pain Scores ◽  
Small Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Feasible Option

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. 

scholarly journals A case of a modified Puestow procedure for recurrent pancreatitis after distal pancreatectomy for chronic pancreatitis

Suizo ◽  
2011 ◽  
Vol 26 (2) ◽  
pp. 225-230
Author(s):  
Koichi TANIGUCHI ◽  
Ryusei MATSUYAMA ◽  
Kazuhisa TAKEDA ◽  
Takafumi KUMAMOTO ◽  
Kazunori NOJIRI ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Distal Pancreatectomy ◽  
Recurrent Pancreatitis ◽  
Puestow Procedure

scholarly journals Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection

2021 ◽  
Vol 12 (1) ◽  
pp. 47-51
Author(s):  
Kunal Sadanand Joshi ◽  
Sisir Bodepudi ◽  
Santhosh Kumar Ganapathi ◽  
Chandrasekar Murugesan ◽  
Jagan Balu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Distal Pancreatectomy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
The Body ◽  
Metastatic Spread ◽  
Pathological Examination ◽  
Jejunal Loop ◽  
En Bloc ◽  
Lateral Pancreaticojejunostomy

Abstract Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.

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