Cystoductojejunostomy for pseudocyst associated with chronic pancreatitis

Abhijna Soori; Biju Pottakkat; Chandrasekar Murugesan; Kalayarasan Raja; Sai Krishna Pothugunta

doi:10.18203/2349-2902.isj20242127

Authors

Abhijna Soori Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Biju Pottakkat Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Chandrasekar Murugesan Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Kalayarasan Raja Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Sai Krishna Pothugunta Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

DOI:

https://doi.org/10.18203/2349-2902.isj20242127

Keywords:

Chronic pancreatitis, Pancreatic duct, Pancreatic head resection, Pseudocyst

Abstract

Pseudocyst is frequently associated with chronic pancreatitis (CP). We describe our experience of managing seven patients for pseudocyst associated with CP by bile duct preserving pancreatic head resection (BDPPHR) and cystoductojejunostomy. 88 patients were operated on for chronic pancreatitis between April 2021 till May 2023 out of which 7 patients underwent BDPPHR and cystoductojejunostomy for pseudocyst associated with CP. Key steps of surgery include meticulous dissection with exposure of the pancreatic head to tail, head excision up to the posterior capsule with laying open of the pancreatic duct till the tail and reconstruction incorporating pancreatic duct (PD) and pseudocyst to a single loop of jejunum. All seven patients were successfully treated with BDPPHR and cystoductojejunostomy. Mean operative time and mean blood loss was 478 minutes and 450 ml respectively. Mean hospital stay was 4.5 days. On follow-up at a one-year minimum, all patients had complete pain relief. In patients with pseudocyst associated with CP, surgery preferably needs to address both the pseudocyst and the underlying chronic pancreatitis to improve the quality of life. A combined anastomosis to the PD and cyst may be termed as cystoductojejunostomy.

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