Longitudinal Pancreatico-gastrostomy, A Quest for a Better Salvage for Chronic Pancreatitis in Bangladesh: An Outcome Analysis of Our Early Cases
Keywords:Pancreatitis, MPD, Longitudinal Pancreatico-gastrostomy, LPG
Background: Chronic pancreatitis being one of the most distressing medical condition, is often complicated by common bile duct obstruction, fibrosis and acute inflammation of the pancreas. Pain, weight loss and diabetes are common in these patients. Surgery is the ultimate option after medical treatment fails to solve the distress. Longitudinal Pancreatico-jejunostomy is widely practiced all over the world as the option of choice. Pancreatico-gastrostomy is also being practiced by a few surgeons in a few centers. Here we practice Longitudinal Pancreaticogastrostomy (LPG) for chronic pancreatitis patients in our setup. This study was aimed to analyze the outcomes and privileges of LPG.
Method: This prospective study was monitored and guided by the Department of Hepatobiliary and Pancreatic Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka over a period of 18 months. A total of 36 patients with chronic pancreatitis were allocated for Longitudinal Pancreatico-gastrostomy (LPG) surgery. Study tools included pain gradation, body weight, investigation profiles- serum lipase, blood sugar, USG of abdomen, CT Scan and MRCP. Duration of surgery, blood loss, hospital stay, assessment of post-operative pain relief and surgical complications were the parameters of the study. For pain relief assessment patients were divided into three categories, complete (no complaint pain), satisfactory (mild tolerable pain with normal daily activities) and unsatisfactory (moderate to severe pain requiring medication and hampered daily activities).
Results: 36 patients in the group underwent LPG. Mean age in group was 22.94 ± 3.76 years. Majority of the patients had unknown etiology. The mean duration of illness in group was 4.27 ±0.96 years. LPG was easier to perform, took less time, less blood loss and hospital stay was short with less post-operative complications. Pain relief was satisfactory with most patients showing complete pain relief. Diabetes patients got much better glycemic control after surgery. Weight gaining was also significant.
Conclusion: LPG is an easier and safer surgery which achieves good pain relief, glycemic control and nutritional improvements. Large volume studies should be done to establish its dominance against other surgical procedures.
J Shaheed Suhrawardy Med Coll 2021; 13(1): 58-62