Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1673
Peer-review started: May 28, 2021
First decision: June 26, 2021
Revised: July 7, 2021
Accepted: November 3, 2021
Article in press: November 3, 2021
Published online: December 27, 2021
The Partington-Rochelle pancreaticojejunostomy (PJ) is an essential management option for patients with chronic pancreatitis (CP) associated with intractable pain and a dilated pancreatic duct (PD). Wide ductotomy and long PJ (L-PJ) have been advocated as the standard of care to ensure full PD decompression. However, the role of short PJ (S-PJ) in a uniformly dilated PD has not yet been evaluated.
To evaluate the possible advantages and disadvantages of S-PJ and L-PJ and to interpret the perspective of S-PJ in the treatment of CP.
A retrospective review of prospectively collected cohort data was conducted on surgically treated CP patients subjected to side-to-side PJ. The length of the PJ was adapted to anatomical alterations in PD. A comparison was made of S-PJ (< 50 mm) for uniformly dilated PD and L-PJ (50-100 mm) in the setting of multiple PD strictures, calcifications and dilatations. We hypothesized that S-PJ and L-PJ ensure comparable clinical outcomes. The primary outcomes were pain relief and quality of life (QOL); the secondary outcomes were perioperative characteristics, body weight, patients’ satisfaction with treatment, and readmission rate due to CP.
Overall, 91 patients underwent side-to-side PJ for CP, including S-PJ in 46 patients and L-PJ in 45 patients. S-PJ resulted in better perioperative outcomes: Significantly shorter operative time (107.5 min vs 134 min), lower need for intraoperative (0% vs 15.6%) and total (2.2% vs 31.1%) blood transfusions, and lower rate of perioperative complications (6.5% vs 17.8%). We noted no significant difference in pain relief, improvement in QOL, body weight gain, patients’ satisfaction with surgical treatment, or readmission rate due to CP.
Based on our data, in the setting of a uniformly dilated PD, S-PJ provides adequate decompression of the PD. As the clinical outcomes following S-PJ are not inferior to those of L-PJ, S-PJ should be preferred as a surgical option in the case of a uniformly dilated PD.
Core Tip: Pancreaticojejunostomy (PJ) is an essential management option in patients with chronic pancreatitis associated with intractable pain and a dilated pancreatic duct (PD). Our retrospective study demonstrated that in the setting of a uniformly dilated PD, short PJ provides adequate decompression of the PD. As the clinical outcomes following short PJ are not inferior to those of long PJ, short PJ should be preferred as a surgical option in the case of a uniformly dilated PD. The use of short PJ is beneficial to patients due to shorter operating time, lower need for blood transfusion and lower rate of surgical complications.