Journal of Visceral Surgery 159 (2022) 436—438
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VISCERAL SURGERY VIDEOS
Robotic longitudinal side to side
pancreaticojejunostomy
(Partington-Rochelle or modified Puestow
procedure) for chronic pancreatitis
(with video)
J.-B. Lequeu ∗, B. Doussot , O. Facy
Dijon University Hospital, Department of Digestive Surgical Oncology, rue Paul-Gaffarel,
Dijon 21000, France
Available online 16 September 2022
Abdominal pain is a major clinical signs in patients with chronic pancreatitis. Current
guidelines recommend medical treatement associated with endoscopy as a first approach
[1]. However, observational studies and a recent randomized clinical trial involving more
than 80 patients showed that surgery performed early in the history of chronic pancreatitis
could offer a better pain control. The use of the robotic platform in this settings could
improve the laparoscopic approach but remains to be evaluated further [2]. This video
shows the case of a 77 year-old male patient with chronic pancreatitis. His past medical
history was chronic alcoholism with an alcohol withdrawal 15 years ago and diabetes. The
patient presented typical pancreatic duct pain with a substantial limitation of his daily
activities with both endocrine and exocrine insufficiency. The CT-scan showed a major
pancreatic atrophy with a ductal dilatation over 1 cm and calcifications in the pancreatic
head without any associated biliary, portal or duodenal compression (Figure 1). MRI and
endoscopic US did not show any argument in favor of malignancy. In this patients, endo-
scopic management was not decided because calcifications in the head of the pancreas
would have led to a failure of endoscopic duct stenting procedure.
∗ Corresponding author.
E-mail address: jean-baptiste.lequeu@chu-dijon.fr (J.-B. Lequeu).
https://doi.org/10.1016/j.jviscsurg.2022.05.005
1878-7886/© 2022 Published by Elsevier Masson SAS.
Journal of Visceral Surgery 159 (2022) 436—438
Figure 3. Longitudinal opening of the main pancreatic duct.
Figure 1. Main pancreatic duct dilatation.
Figure 4. Precolic pancreaticojejunostomy.
the different steps necessary to perform a longitudinal side
Figure 2. Opening of the lesser sac. to side pancreaticojejunostomy. It will be usefull for all
surgical teams having to manage patients with chronic pan-
creatitis.
This video shows a robotic assisted longitudinal side to
side pancreaticojejunostomy [3]. The patient was placed
in supine position, robotic cart was positioned at the level
of his head and 5 ports were inserted. Section of the gas- Online Supplement. Supplementary data
trocolic ligament and opening of the lesser sac allowed
to the exposure of the pancreas (Figure 2). The splenic Supplementary data associated with this article can
artery was preserved at the upper border of the pancreas. be found, in the online version, at https://doi.org/
A large longitudinal opening of the main pancreatic duct 10.1016/j.jviscsurg.2022.05.005.
from the neck to the tail was performed (Figure 3). The
stones trapped in the wall of the pancreatic head could not
be extracted. After the preparation of a jejunal afferent Disclosure of interest
loop 60 cm from the angle of Treitz, a side to side precolic
pancreaticojejunostomy with barbed sutures was performed The authors declare that they have no competing interest.
(Figure 4). Then, a jejunojejunal anastomosis with barbed
sutures was performed about 60 cm downward with clo-
sure of the mesenteric defect using non absorbable sutures. References
Lastly, the jejunum between the pancreaticojejunostomy
and the jejunojejunal anastomosis was sectionned using [1] Partington PF, Rochelle RE. Modified Puestow procedure
a mecanic stappler to obtain a Roux-en-Y procedure. The for retrograde drainage of the pancreatic duct. Ann Surg
operation duration was 180 minutes with no intraoperative 1960;152:1037—43.
complication or blood loss. The patient had no postopera- [2] Issa Y, Kempeneers MA, Bruno MJ, et al. Effect of Early surgery
tive complication and discharged by day 3. This video shows vs endoscopy-first approach on pain in patients with chronic
437
J.-B. Lequeu, B. Doussot and O. Facy
pancreatitis: The ESCAPE randomized clinical trial. J.A.M.A group for the international consensus guidelines for chronic
2020;323:237—47. pancreatitis in collaboration with the International Associa-
[3] Masayuki Kitano, Thomas M, Gress, Pramod K, et al. Inter- tion of Pancreatology, the American Pancreatic Association, the
national consensus guidelines on interventional endoscopy Japan Pancreas Society, and European Pancreatic Club, Pancre-
in chronic pancreatitis. Recommendations from the working atology 2020;20:1045-1055.
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