Minimally invasive surgery for chronic pancreatitis as main and auxiliary options?

Abstract

Purpose: Explore the possibilities of minimally invasive surgery for chronic pancreatitis (CP). What is the role of endoscopy, interventional sonography and laparoscopic surgery. Can these procedures be main or auxiliary?

Materials and methods: We analyzed the results of surgical treatment of 258 patients with CP. Of these, minimally invasive surgery, was realized in 108 patients. Endoscopic transpap?llary procedure were made in 22 (20,4%) patients. The indications for their implementation was biliary and pancreatic hypertension, and external pancreatic fistulas. Endoscopic transmural procedures performed in 10 (9,2%) patients. Interventional sonography techniques were used in 70 (64,8%) patients with enormous pancreatic pseudocysts. Laparoscopic surgery was performed in 5 (4,6%) patients, including two successful total laparoscopic longitudinal pancreatojejunostomy.

Results: Endoscopic transpapillary procedures with sufficient selection of patients eliminate the biliary and pancreatic hypertension, but does not have long-term effects and serve as the first stage of surgery. Endoscopic transmural anastomoses with the clear indications are effective. Interventional sonography techniques play an important but supporting role, breaking surgery on the steps and eliminate the main complications of the disease. With four attempts, the total laparoscopic longitudinal pancreatojejunostomy was performed in 2 patients. In 2 patients, a conversion was made. The average operation time was 207 minutes. The post-operative stay was an average of 9 days, and the average follow-up observation period was 13 months. There were no pancreatic fistulas and fatal cases. All patients in the long-term outcome noticed pain disappearance and weight gain. According to the questionnaires SF-36 and EORTC BCH there was a significant improvement on functional scales.

Conclusions:

1. Endoscopic transpapillary procedures and transmural anastomosis with clear indications are sufficiently effective but give a short-term effect, and government cases have auxiliary value.
2. Methods of interventional sonography in the treatment of complications of chronic pancreatitis play an auxiliary therapeutic role, breaking surgical treatment at stages, eliminating the main complications of the disease or surgery
3. Laparoscopic surgery, especially laparoscopic longitudinal pancreatojejunostomy for patients with «early chronic pancreatitis» with pancreatic hypertension without enlarging the head of pancreas, are technically possible and attractive.