EARLY POSTOPERATIVE OUTCOME OF LATERAL PANCREATICOJEJUNOSTOMY IN CHRONIC PANCREATITIS

Dr. Mohammad Tawfik Aziz Shaon*, Dr. Tanveer Ahmed, Dr. Md. Saidul Anwar, Dr. Akram Hossain Khan, Dr. Md. Ashraful Islam and Dr. Md. Khalilur Rahman Khabir

ABSTRACT

Background: Chronic pancreatitis is an inflammatory disease characterized by irreversible destruction of the pancreas with progressive loss of functional parenchyma ultimately resulting in endocrine and exocrine insufficiency. The most common symptom is intractable pain. The different treatment options for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery. Surgical intervention is required in patients with unmanageable pain resistant to narcotic use. Many studies have established the benefits of surgical treatment in chronic pancreatitis. The surgical drainage procedure most commonly performed is the lateral pancreaticojejunostomy (LPJ) due to its safety and feasibility. The objective of this study was to evaluate post operative outcome of LPJ in patient with chronic pancreatitis. Objectives: To get an effective procedure to relieve the sign symptoms as well as to evaluate the effectiveness of Lateral Pancreaticojejunostomy in patient with chronic pancreatitis. Methods: This was an observational study which is conducted at Department of Surgery, Dhaka Medical College Hospital from 06th June 2018 to 05th June 2019. Total 50 cases of chronic pancreatitis with evidence of a dilated pancreatic duct (8 mm or more) and planned for lateral pancreaticojejunostomy were enrolled for study after fulfillment of selection criteria. Sample was selected by consecutive sampling technique. Data were collected from the patients and/or informant and recorded in structured case record form. Clinical examination and relevant investigations were done meticulously. Lateral pancreaticojejunostomy was done according to operational definition. Post operative follow up was documented during follow up period. Follow up period was 3 months after surgery. Outcome was evaluated. All the demographic variables and perioperative variables were studied and compared. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Comparison was done by tabulation in the form of tables. Results: The study was carried out on the consecutive 50 clinically diagnosed chronic pancreatitis patients who admitted in the departments of surgery unit of Dhaka Medical College Hospital (DMCH). The observations were also compared with results of other similar sorts of studies done at different parts of the world. In this study maximum numbers of patients (44.0%) were between 31-40 years age group, mean±SD age was 43.7±10.2 years. Middle to elderly aged patients were high in contrast to elderly age groups. In this study most common symptoms were abdominal pain, anorexia and generalized weakness (76.0%, 46.0% & 88.0% respectively). In this study all patients were conducted lateral pancreaticojejunostomy. Early post operative outcome, measured by pain relief and postoperative morbidity and mortality, have been excellent; however, long-term follow-up and overall outcome has been less clearly defined in these patients. Study shows that clinical improvement of exocrine insufficiency was found in 22(75.0%) patients out of 29 pre operative exocrine insufficient patients at first follow-up, subsequently only 4(14%) patients found poor outcome. 27 patients were diabetic and getting insulin or oral hypoglycemics pre operatively. The daily dose of insulin was decreased following surgery in 12% of patients. 8.0% patients developed pancreatic fistula & it was resolved by conservative management. All the patients had a period of hospital stay about 7-10 days post operatively. At first follow up, 9(18%) patients were rehospitalized, out of them 7(78%) were for recurrent attack of pain and 2(22%) were for development of abscess. At second follow up, only 3(6%) patients were admitted for recurrent attack of pancreatitis. Overall early postoperative morbidity rate was 14.0%. In this study after treatment, patient's compliance and outcome of surgery was evaluated. Present study shows that, 24(48.0%) good outcome, 19(38.0%) fair outcome and 7(14.0%) revealed poor outcome in terms of pain relieve. Conclusion: Present study concluded that lateral pancreaticojejunostomy is a safe and feasible technique for chronic pancreatitis treatment.

Keywords: Chronic pancreatitis, Pancreaticojejunostomy, therapeutic endoscopy.