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Laparoscopic Puestow Procedure for Chronic Pancreatitis in Children
Apurva Arora1, Prakash Agarwal1, Rajkishore Bagdi1
1Department of Pediatric Surgery, Sri Ramachandra University, Chennai, Tamil Nadu, India.
Insights
Laparoscopic Puestow procedure offers a minimally invasive surgical option for managing chronic pancreatitis (CP) in children. This approach successfully relieved pain and improved outcomes in three pediatric patients with CP.
Area of Science:
- Gastroenterology and Hepatology
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Chronic pancreatitis (CP) involves pancreatic fibrosis and calcification, potentially leading to endocrine/exocrine insufficiency and severe pain.
- Pain in CP is often linked to ductal/parenchymal hypertension and perineural inflammation.
- The Puestow procedure (longitudinal pancreaticojejunostomy) is effective for ductal hypertension but its application in children via laparoscopy is emerging.
Observation:
- Three pediatric patients (ages 10, 12, 16) with chronic pancreatitis were identified.
- All patients presented with symptoms indicative of CP requiring surgical intervention.
- The laparoscopic Puestow procedure was performed on all three patients.
Findings:
- Successful management of chronic pancreatitis was achieved in all three pediatric patients.
- The laparoscopic Puestow procedure provided symptomatic relief, likely through ductal decompression.
- No major complications were reported, indicating the safety and efficacy of the minimally invasive approach in this cohort.
Implications:
- Laparoscopic Puestow procedure is a viable and effective minimally invasive surgical option for pediatric chronic pancreatitis.
- This technique may offer a less invasive alternative to open surgery for children with CP.
- Further research and larger studies are warranted to establish long-term outcomes and solidify its role in pediatric surgical practice.
Abstract:
Chronic pancreatitis (CP) is a sequelae characterized by recurrent attacks of pancreatitis leading on to fibrosis and calcification of both ductal and parenchymal elements of the pancreas. Most of these, if left untreated at the right time, will lead on to burnt-out pancreas with complete atrophy of the parenchyma, leading on to endocrine/exocrine insufficiency. The pain in such patients is most likely due to ductal hypertension, parenchymal hypertension, and head mass causing perineural inflammation. Puestow procedure (longitudinal pancreaticojejunostomy) is the surgery of choice in selected patients with ductal hypertension where decompression of the duct provides symptomatic relief. Performance of such procedures in children by minimal access laparoscopic method is still evolving. We report a series of three patients (aged 10, 12, and 16 years) diagnosed with CP and successfully managed by laparoscopic Puestow procedure.
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Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
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