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Wednesday, May 23, 2007


The following was an assessment that I do not share completely today: I agree with the sceptics that there is every reason to avoid over-enthusiastic surgery for chronic pancreatitis. I am very conservative with these patients and advise surgery when pain-killing celiac ganglion blocks, enzyme supplements, etc. fail abjectly.
Anyways, here is what I had to claim in 2004-2005:

Laparoscopic pancreatic surgery has usually been restricted to

staging for malignancy,internal drainage of pseudocysts and

left-sided resections.

However, the more complex procedures for chronic pancreatitis

and cancer of the head of pancreas are also worth considering.

Laparoscopic Whipple’s operation, while affording spectacular

views and being a great exercise in laparoscopic skills, is

unlikely to become popular in the near future, owing to its

complexity and the lack of evidence regarding its benefits.

Laparoscopic palliation for cancer of the head of pancreas is

technically less difficult. 16 bypass procedures have been done

without any major complications.

Laparoscopic surgery for chronic pancreatitis is another niche

area where there is very little world literature.

Of the drainage procedures for chronic pancreatitis, laparoscopic

pancreaticojejunostomy is more classical but more tedious.

The newer procedure of lap pancreaticogastrostomy is

superior because of its near-zero leak rate, ease and simplicity of

the technique, and efficacy. In our developing series of cases, we

have not had any leak or complication with the procedure.

It is likely that in the near future, lap pancreaticogastrostomy will

be the procedure of choice for the disease.


Department of Minimally Invasive Surgery
Anandalok Hospital

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