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      Laparoscopic longitudinal pancreatojejunostomy and modified Frey's operation for chronic calcific pancreatitis

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          Abstract

          Background

          Chronic pancreatitis is a debilitating disease presenting with pain, diabetes and steatorrhoea. Surgery offers better long‐term pain relief than other interventions, but there is still uncertainty about the optimal surgical procedure and approach and a lack of long‐term follow‐up data in patients with chronic calcific pancreatitis selected for laparoscopic surgical treatment.

          Methods

          This was an observational cohort study of patients who underwent laparoscopic surgery for chronic calcific pancreatitis between January 2006 and April 2017, and had completed a minimum follow‐up of 1 year at a tertiary‐care teaching institute. Eligibility for the laparoscopic approach was main duct diameter greater than 7 mm, absence of extensive head calcification, size of head less than 3·5 cm, absence of local complications, and ASA grade I or II status. The primary outcome variable was a reduction in pain score by 1 year. Secondary outcomes were hospital stay, complications, pain score at 3 and 5 years, and the development or progression of exocrine and endocrine insufficiency.

          Results

          Some 57 patients were scheduled to undergo laparoscopic surgery for chronic pancreatitis: longitudinal pancreatojejunostomy (39), modified Frey's procedure (15) and pancreatoduodenectomy for suspicion of malignancy (3). The latter three patients were excluded from the analysis. Conversion to open surgery was needed in ten of the 57 patients (18 per cent). The mean(s.d.) age of the analysed cohort was 34·2(3·7) years and there was a predominance of men (34, 63 per cent). Adequate pain relief was achieved in 91, 89 and 88 per cent of patients at 1, 3 and 5 years of follow‐up respectively.

          Conclusion

          Laparoscopic surgical management of chronic calcific pancreatitis with longitudinal pancreatojejunostomy or modified Frey's procedure is feasible, safe and effective in selected patients for the relief of pain.

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          Most cited references11

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          Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.

          For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct. All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study. We randomly assigned patients to undergo endoscopic transampullary drainage of the pancreatic duct or operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function. Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores (25 vs. 51, P<0.001) and better physical health summary scores on the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire (P=0.003). At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage as compared with 75% of patients assigned to surgical drainage (P=0.007). Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group (a median of eight vs. three, P<0.001). Surgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis. (Current Controlled Trials number, ISRCTN04572410 [controlled-trials.com].). Copyright 2007 Massachusetts Medical Society.
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            Quality of life in chronic pancreatitis--results after duodenum-preserving resection of the head of the pancreas.

            Studies on chronic pancreatitis have focused predominantly on pain measurement, morbidity, and mortality. In this prospective follow-up study the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) was reevaluated for patients suffering from chronic pancreatitis. Pain intensity was quantified using a specially designed pain score. Twenty-five patients with chronic pancreatitis underwent duodenum-preserving pancreatic head resection. The QLQ, Spitzer's quality of life index, and the pain score were assessed twice before surgery, before discharge, and 6 and 18 months after surgery. The interscale reliability (Cronbach's coefficient alpha > or = 0.70) was confirmed for all multiitem scales except preoperative working ability. Test-retest stability for the QLQ was 94%. The QLQ correlated closely with Spitzer's quality of life index (r = 0.985, p < 0.001) and changes in body weight (r = 0.764, p < 0.001). After 18 months physical status, working ability, emotional and social functioning, and global quality of life had improved by 44, 50, 50, 60, and 67%, respectively, showing good responsiveness of the QLQ. The pain score decreased by 95% (p < 0.001). The EORTC quality of life questionnaire represents a reliable and valid measure of quality of life in patients with chronic pancreatitis.
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              Systematic review of early surgery for chronic pancreatitis: impact on pain, pancreatic function, and re-intervention.

              Surgical intervention has traditionally been reserved as the last management option for pain in chronic pancreatitis. Recently, there has been a call for surgery to be offered earlier in the disease process. The objectives of this review were to evaluate the effect of early surgery on postoperative pain, pancreatic function, and re-intervention rates in chronic pancreatitis.
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                Author and article information

                Contributors
                drsandeepsabnis@gmail.com
                Journal
                BJS Open
                BJS Open
                10.1002/(ISSN)2474-9842
                BJS5
                BJS Open
                John Wiley & Sons, Ltd (Chichester, UK )
                2474-9842
                24 June 2019
                October 2019
                : 3
                : 5 ( doiID: 10.1002/bjs5.v3.5 )
                : 666-671
                Affiliations
                [ 1 ] Department of Surgical Gastroenterology and HPB Surgery GEM Hospital and Research Centre, 45/A, Pankaja Mill Road, Ramanathapuram, Coimbatore Tamil Nadu–641045 India
                Author notes
                [*] [* ] Correspondence to: Dr S. C. Sabnis (e‐mail: drsandeepsabnis@ 123456gmail.com ; @drsandeepsabnis; @GEMHospitals)
                Author information
                https://orcid.org/0000-0001-7935-1505
                Article
                BJS550185
                10.1002/bjs5.50185
                6773625
                31592076
                936f59ec-cf58-48ab-a76d-a4531afd25eb
                © 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 January 2019
                : 23 April 2019
                Page count
                Figures: 5, Tables: 3, Pages: 6, Words: 2565
                Categories
                HPB
                Original Article
                Original Articles
                Custom metadata
                2.0
                bjs550185
                October 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:01.10.2019

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