BACKGROUND: The treatment of chronic pancreatitis requires a surgical approach in patients who are refractory to medical therapy. During surgical treatment, ductal decompression is required, but a pancreatectomy is necessary for some patients, such as those with severe stenosis of the pancreatic duct. Indeed, suboptimal procedures lead to recurrent pancreatitis. We used a laparoscopic hybrid approach for patients with severe stenosis of the pancreatic duct. In this report, we present the feasibility and outcomes of our approach. METHODS: We selected a laparoscopic approach for the distal pancreatectomy, which is relatively safe and the effect of reducing the length of the wound is substantial. We selected an open approach for the Frey procedure because complete ductal compression has a high risk for injury to the vessels posterior to the pancreas. We recorded the operative outcomes, postoperative complications, and recurrence of pancreatitis. RESULTS: We performed the laparoscopic hybrid approach on 3patients between January and December 2018. There were no major intraoperative complications (Clavien-Dindo classification IIIa or more) and the postoperative course was uneventful in all patients. There were no recurrences of pancreatitis and no postoperative pain in all patients in > 2 years of follow-up. CONCLUSION: Our hybrid method with a focus on complete ductal compression with safety and minimal invasiveness might be the optimal approach for the surgical treatment of chronic pancreatitis that requires a pancreatectomy with the Frey procedure.
BACKGROUND: The treatment of chronic pancreatitis requires a surgical approach in patients who are refractory to medical therapy. During surgical treatment, ductal decompression is required, but a pancreatectomy is necessary for some patients, such as those with severe stenosis of the pancreatic duct. Indeed, suboptimal procedures lead to recurrent pancreatitis. We used a laparoscopic hybrid approach for patients with severe stenosis of the pancreatic duct. In this report, we present the feasibility and outcomes of our approach. METHODS: We selected a laparoscopic approach for the distal pancreatectomy, which is relatively safe and the effect of reducing the length of the wound is substantial. We selected an open approach for the Frey procedure because complete ductal compression has a high risk for injury to the vessels posterior to the pancreas. We recorded the operative outcomes, postoperative complications, and recurrence of pancreatitis. RESULTS: We performed the laparoscopic hybrid approach on 3patients between January and December 2018. There were no major intraoperative complications (Clavien-Dindo classification IIIa or more) and the postoperative course was uneventful in all patients. There were no recurrences of pancreatitis and no postoperative pain in all patients in > 2 years of follow-up. CONCLUSION: Our hybrid method with a focus on complete ductal compression with safety and minimal invasiveness might be the optimal approach for the surgical treatment of chronic pancreatitis that requires a pancreatectomy with the Frey procedure.
Authors: Usama Ahmed Ali; Johanna M Pahlplatz; Wiliam H Nealon; Harry van Goor; Hein G Gooszen; Marja A Boermeester Journal: Cochrane Database Syst Rev Date: 2015-03-19
Authors: Djuna L Cahen; Dirk J Gouma; Yung Nio; Erik A J Rauws; Marja A Boermeester; Olivier R Busch; Jaap Stoker; Johan S Laméris; Marcel G W Dijkgraaf; Kees Huibregtse; Marco J Bruno Journal: N Engl J Med Date: 2007-02-15 Impact factor: 91.245
Authors: B Lamme; M A Boermeester; I H Straatsburg; J M van Buijtenen; D Boerma; G J A Offerhaus; D J Gouma; T M van Gulik Journal: Br J Surg Date: 2007-07 Impact factor: 6.939
Authors: Yama Issa; Marco J Bruno; Olaf J Bakker; Marc G Besselink; Nicolien J Schepers; Hjalmar C van Santvoort; Hein G Gooszen; Marja A Boermeester Journal: Nat Rev Gastroenterol Hepatol Date: 2014-06-10 Impact factor: 46.802