Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1673-1684
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1673
‘Short’ pancreaticojejunostomy might be a valid option for treatment of chronic pancreatitis in many cases
Marko Murruste, Ülle Kirsimägi, Karri Kase, Tatjana Veršinina, Peep Talving, Urmas Lepner
Marko Murruste, Ülle Kirsimägi, Karri Kase, Tatjana Veršinina, Urmas Lepner, Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
Marko Murruste, Karri Kase, Tatjana Veršinina, Peep Talving, Urmas Lepner, Faculty of Medicine, University of Tartu, Tartu 50411, Estonia
Peep Talving, Division of Acute Care Surgery, Department of Surgery, North-Estonia Medical Centre, Tallinn 13419, Estonia
Author contributions: Murruste M, Kirsimägi Ü, Kase K, Veršinina T, Talving P and Lepner U designed the study; Murruste M, Kirsimägi Ü, Kase K and Veršinina T performed the study; Murruste M and Kirsimägi Ü produced statistics and wrote the paper.
Institutional review board statement: The Research Ethics Committee of the University of Tartu approved this study (approval No. N 291/T-1).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marko Murruste, MD, Doctor, Surgeon, Department of Surgery, Tartu University Hospital, 8 Puusepa str, Tartu 50406, Estonia. marko.murruste@kliinikum.ee
Received: May 28, 2021
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
ARTICLE HIGHLIGHTS
Research background

The Partington-Rochelle pancreaticojejunostomy (PJ) is an essential management option in 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. Nevertheless, the role of short PJ (S-PJ) in uniformly dilated PD has not yet been evaluated.

Research motivation

The aim of this study was 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.

Research objectives

We hypothesized that S-PJ and L-PJ ensure comparable clinical outcomes. The primary outcomes were pain relief and quality of life, secondary outcomes were perioperative characteristics, body weight, patients’ satisfaction with treatment, and readmissions rate due to CP.

Research methods

A retrospective review of prospectively collected cohort data was conducted on surgically treated CP patients subjected to side-to-side PJ. The length of PJ adapted to anatomical alterations in PD: A S-PJ (< 50 mm) in uniformly dilated PD, and a L-PJ (50-100 mm), in the setting of multiple PD strictures, calcifications and dilatation were compared.

Research results

S-PJ resulted in improved 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 quality of life, body weight gain, patients’ satisfaction with surgical treatment, and readmission rate due to CP.

Research conclusions

Based on our data, in the setting of a uniformly dilated PD, the 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 a uniformly dilated PD.

Research perspectives

It would be important to compare randomly selected patients with uniformly dilated PD using either S-PJ or L-PJ.