Is any surgical procedure ideal for chronic pancreatitis?

Surgical drainage procedures for paediatric chronic pancreatitis: a scoping review

Paediatric chronic pancreatitis (CP) is a relatively rare entity, but it can be accompanied by debilitating complications such as pseudocysts, chronic pain and pancreatic duct obstruction. Surgical drainage procedures, such as pancreaticojejunostomy or cystogastrostomy/jejunostomy to address these complications may be required; however, there is a paucity of evidence as to the efficacy and long-term outcomes of these operations in the paediatric population. A scoping review of contemporary (post-2000) studies detailing surgical pancreatic drainage procedures performed in children (< 18 years) was undertaken. After screening, 24 case series detailing a total of 248 patients met the inclusion criteria. Longitudinal pancreaticojejunostomy and cystogastrostomy were the most common surgical procedures performed in children with CP and pseudocysts, respectively. Overall generally favourable outcomes were reported, but all studies were considered to have a high risk of bias. Operative management for paediatric CP is infrequently required; therefore, large prospective studies or trials focusing on this population are infeasible, limiting the best available evidence on the topic to case series, level IV. Recommendations to improve the quality of surgical care in the paediatric CP population could include centralisation and the formation of registries to allow accurate long-term follow-up.

‘Short’ pancreaticojejunostomy might be a valid option for treatment of chronic pancreatitis in many cases

BACKGROUND

The Partington-Rochelle pancreaticojejunostomy (PJ) is an essential management option for patients with chronic pancreatitis (CP) associated with intractable pain and a dilated pancreatic duct (PD). Wide ductotomy and long PJ (L-PJ) have been advocated as the standard of care to ensure full PD decompression. However, the role of short PJ (S-PJ) in a uniformly dilated PD has not yet been evaluated.

AIM

To evaluate the possible advantages and disadvantages of S-PJ and L-PJ and to interpret the perspective of S-PJ in the treatment of CP.

METHODS

A retrospective review of prospectively collected cohort data was conducted on surgically treated CP patients subjected to side-to-side PJ. The length of the PJ was adapted to anatomical alterations in PD. A comparison was made of S-PJ (< 50 mm) for uniformly dilated PD and L-PJ (50-100 mm) in the setting of multiple PD strictures, calcifications and dilatations. We hypothesized that S-PJ and L-PJ ensure comparable clinical outcomes. The primary outcomes were pain relief and quality of life (QOL); the secondary outcomes were perioperative characteristics, body weight, patients’ satisfaction with treatment, and readmission rate due to CP.

RESULTS

Overall, 91 patients underwent side-to-side PJ for CP, including S-PJ in 46 patients and L-PJ in 45 patients. S-PJ resulted in better perioperative outcomes: Significantly shorter operative time (107.5 min vs 134 min), lower need for intraoperative (0% vs 15.6%) and total (2.2% vs 31.1%) blood transfusions, and lower rate of perioperative complications (6.5% vs 17.8%). We noted no significant difference in pain relief, improvement in QOL, body weight gain, patients’ satisfaction with surgical treatment, or readmission rate due to CP.

CONCLUSION

Based on our data, in the setting of a uniformly dilated PD, S-PJ provides adequate decompression of the PD. As the clinical outcomes following S-PJ are not inferior to those of L-PJ, S-PJ should be preferred as a surgical option in the case of a uniformly dilated PD.

[Surgical management of chronic pancreatitis complicated by biliary and duodenal obstruction]

AIM

To compare different surgical approaches to chronic pancreatitis complicated by biliary and duodenal obstruction.

MATERIAL AND METHODS

In the study (n=42) and control (n=36) groups 18 and 4 resections were performed respectively (p=0.004). Early postoperative complications occurred in 15 cases of the study group and 4 cases of the control group (p=0.024). 7 and 1 re-operations were made in both groups respectively (p=0.99). There was no postoperative mortality in both groups. There were 4 cases of return to false-negative results of intraoperative biopsy in the control group. In these patients resection was possible during primary surgery.

CONCLUSION

Resections are advisable for chronic pancreatitis complicated by obstructive jaundice and duodenal obstruction because it eliminates biliary and duodenal obstruction and can accurately determine the nature of disease.

Endoscopic versus surgical treatment of chronic pancreatitis: A systematic review

AIM: To compare the long-term clinical outcomes and complications between endoscopic and surgical treatment of chronic pancreatitis.

METHODS: An electronic search of Medline, EMBASE, Science Direct, Springer link, CBM, CNKI, Wan fang and VIP databases (before December 21, 2013) was performed to retrieve the articles reporting endoscopic versus surgical treatment of chronic pancreatitis. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed using RevMan 5.2.7 software.

RESULTS: A total of 5 articles involving 393 chronic pancreatitis patients were included in the analysis, including 4 English articles and 1 Chinese article. The meta-analysis showed that the patients undergoing surgical treatment had higher rates of pain relief and complete pain relief (P < 0.05), but there were no significant differences in the rate of partial relief, incidence of diabetes at 1, 3, and 5 years after treatment, the incidence of complications, or endocrine and exocrine functions of the pancreas (P > 0.05).

CONCLUSION: Surgical treatment is associated with better quality of life than endoscopic treatment. Due to the traumatic risk of surgery, endoscopic treatment is safe, and can be the first choice for treatment of chronic pancreatitis.