Chapter 17. Operative Management of Chronic Pancreatitis

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.