Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy

Abstract

Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (LR-LPJ) was performed in 50 patients, and the results were reported at the American Surgical Association meeting in San Antonio, Texas, on April 8, 1994. The operation was not performed in patients whose ducts were less than 4.5 mm in diameter. There were no operative deaths. Forty-seven patients were followed for an average of 37 months. Forty-three of the 50 patients were alcoholics. Pseudocysts were present in 50% of the patients. Thirty-five intraabdominal operations had previously been performed on 23 patients. Preoperatively, all patients underwent computed tomography. Endoscopic retrograde cholangiopancreatography was performed in 82% of patients and angiography in 64%. Preoperatively, all patients had pain. Common bile duct obstruction was present in 8% of patients. The average length of hospital stay was 18.7 days. Postoperative complications occurred in 22% of patients. Pain relief was judged excellent in 74.5%, improved in 12.75%, and unimproved in 12.75%. The pain assessment included use of a pain scale and the monitoring of narcotic usage. Progression of diabetes occurred in 2 patients in the immediate postoperative period and in 3 patients at 3, 16, and 22 months, respectively. Exocrine function, based on the presence of steatorrhea, improved in 10 patients (22%) and deteriorated in 5 (11%). Weight gain was noted in 25 patients and weight loss in 13. Few patients not working preoperatively returned to work postoperatively (15.9%). Aside from pain relief, the operation is also useful in the management of patients with stricture of the intrapancreatic portion of the common duct, pseudocysts, pancreatic ascites, and pancreatic fistulas. LR-LPJ is not indicated in patients in whom there is a suspicion of pancreatic cancer, nor in patients with splenic vein thrombosis and left-sided portal hypertension or pseudoaneurysm of the peripancreatic vessels in the absence of some additional procedure to correct these problems. Patients with a small main pancreatic duct, <4.5 mm, having common duct and duodenal obstruction are best treated by pancreaticoduodenectomy. Patients with a small main pancreatic duct whose disease is limited to the body and tail of the pancreas are best treated by distal pancreatectomy.