Pancreatico-Jejunostomy

Abstract

Reduced port laparoscopic surgery (RPLS) is now being performed for various procedures usually done by the conventional laparoscopic approach. Advanced procedures are now possible with RPLS, and pancreatic surgery is no exception. Chronic calcifying pancreatitis with dilated duct and intraductal calculus is one such condition wherein for properly selected patients lateral pancreaticojejunostomy (LPJ) can be safely performed by this approach. Though many access devices are available, the single incision multipuncture technique allows performing this procedure without compromising the patient’s safety while at the same time facilitating intracorporeal suturing. We use three trocars through a 2.5-cm umbilical incision that are spaced 1 cm from each other. A long scope with an axial light cable connection and varying length of routine instruments make this procedure ergonomically sound. Varying retraction techniques are used, including hooking the stomach to the anterior abdominal wall. Key steps of this procedure include complete exposure of pancreas, removal of the entire stone from the pancreatic duct, and Roux-en-Y reconstruction. The wound is closed with facial sutures. Our preliminary experience shows that single incision laparoscopic LPJ is feasible and safe when performed by an experienced laparoscopic surgeon. It has a cosmetic advantage over laparoscopic LPJ.