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Longitudinal Pancreaticojejunostomy

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  • Severe persistent pain from chronic pancreatitis.
    • Refractory to medical therapy.
    • Repeated hospital admissions.
  • Dilated pancreatic duct > 8 mm in diameter.

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Pancreatic Pseudocyst-Gastrostomy and Pseudocyst-Jejunostomy

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  • Persistent pancreatic pseudocyst present for > 6 weeks (ie, at which time the wall should be mature enough to hold sutures).

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Longitudinal Pancreaticojejunostomy

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Absolute

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  • Absence of pain.
  • Pancreatic cancer.
  • Cirrhosis.

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Relative

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  • Cardiopulmonary comorbidities.

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Pancreatic Pseudocyst-Gastrostomy and Pseudocyst-Jejunostomy

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Absolute

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  • Cystadenocarcinoma is a contraindication to enteric drainage and should be resected.
  • Pseudocyst that has been present for < 6 weeks.

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Relative

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  • Cardiopulmonary comorbidities.

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  • The patient should be supine.
  • The abdomen is entered through a midline incision.

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  • Nothing by mouth with nasogastric tube decompression.
  • Oral diet is advanced following removal of the nasogastric tube and resolution of the postoperative ileus.

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  • Pancreatic leak.
  • Surgical site infections.
  • Bleeding from within the pseudocyst cavity.
    • Can occur intraoperatively or postoperatively and be very difficult to control.
    • Angiographic techniques (eg, embolization) can sometimes be effective in controlling hemorrhage from the pseudocyst cavity.

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