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Home Books CURRENT Procedures: Surgery

Chapter 17. Operative Management of Chronic Pancreatitis

Jules Lin, MD; Diane M. Simeone, MD

Longitudinal Pancreaticojejunostomy

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

Pancreatic Pseudocyst-Gastrostomy and Pseudocyst-Jejunostomy

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

Longitudinal Pancreaticojejunostomy

Absolute

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

Relative

  • Cardiopulmonary comorbidities.

Pancreatic Pseudocyst-Gastrostomy and Pseudocyst-Jejunostomy

Absolute

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

Relative

  • Cardiopulmonary comorbidities.

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

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

  • 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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