Lateral pancreatico-jejunostomy: a case series

Abstract

Chronic pancreatitis and tropical pancreatitis lead to frequent abdominal pain. To reduce this pain, lateral pancreaticojejunostomy (LPJ) is the most common surgical procedure. Despite the evidence available for the effectiveness of surgical therapy, the decision for indication, type, and timing of surgical intervention is always been debated. In this case series we make an attempt to define the possible timing of the procedure and the category of patients who might benefit from it. The 14 out of 65 patients who were evaluated from July 2018 to December 2021 were included in this study. All patients were observed with pain in the abdomen, weight loss, steatorrhea, and malabsorption while none of the patients had pancreatic head mass as per cross-sectional imaging. Fourteen patients with confirmed chronic atrophic pancreatitis with severe symptoms and dilatation of the pancreatic duct were operated upon. Three of these were considered failures since they continued to have no weight gain and either pain or malabsorption. The failures were mainly due to impaired pancreas due to chronic disease and not due to failure of the procedure. Chronic pancreatitis cases, with a short duration of illness, have a better chance of success in surgery. We conclude that one can resort to LPJ in cases that do not respond to medical therapy, continue to suffer from pain, malabsorption, and weight loss. It is a relatively safe procedure that provides good pain relief with low postoperative morbidity, further preventing exacerbations and maintaining appropriate pancreatic exocrine and endocrine functions.