'Head-first Approach' for small duct chronic pancreatitis

Area of Science:

• Gastroenterology and Hepatology
• Surgical Innovation
• Pancreatic Diseases

Background:

• Small duct pancreatitis, a rare chronic pancreatitis variant, traditionally requires resectional surgery with poor long-term outcomes.
• Parenchyma-preserving extended drainage procedures offer better pain relief and quality of life but face technical challenges in identifying the main pancreatic duct (MPD).

Purpose of the Study:

• To introduce and evaluate the efficacy of the "head-first approach" for identifying the MPD in patients with small duct pancreatitis undergoing extended drainage procedures.

Main Methods:

• A retrospective study of 12 patients with small duct pancreatitis who underwent the "head-first approach" for MPD identification during extended drainage procedures between April 2017 and March 2023.
• Data collected included median blood loss, time to duct identification, and post-operative complications.

Main Results:

• The "head-first approach" was successfully used in all 12 patients.
• Median blood loss was 180 mL, and median time to duct identification was 45 minutes.
• Post-operative complications included bleeding (4 patients), pancreatic fistula (2 patients), and surgical site infection (2 patients), all managed conservatively without re-intervention or mortality.

Conclusions:

• The "head-first approach" is a safe and feasible technique for identifying the MPD in small duct pancreatitis.
• This method facilitates parenchyma-preserving extended drainage procedures, offering advantages for surgical pain palliation in this patient group.