Abstract
Introduction Chronic pancreatitis (CP) can be a cause of recurrent, severe, disabling abdominal
pain in children. Surgery has been suggested as a useful therapy, although experience
is limited and the results unpredictable. We reviewed our experience of a two-stage
protocol—preliminary endoscopic retrograde cholangiopancreatography (ERCP) and duct
stenting, and if symptoms resolved, definitive surgical decompression by longitudinal
pancreatojejunostomy (LPJ) (Puestow operation).
Patients and Methods This is a single-center, retrospective review of children with established CP who
underwent an LPJ between February 2002 and September 2012. A questionnaire was completed
(incorporating visual analog scale pain and lifestyle scores) to assess functional
outcome. Data are expressed as median (range).
Results In this study, eight (M:F ratio of 4:4) children underwent an LPJ and one female
child had a more limited pancreatojejunostomy anastomosis following preliminary ERCP
and stent placement where possible. Diagnoses included hereditary pancreatitis (n = 3), idiopathic or structural pancreatitis (n = 5), and duct stricture following radiotherapy (n = 1). Median duct diameter presurgery was 5 (4–11) mm. Endoscopic placement of a
Zimmon pancreatic stent was possible in six with relief of symptoms in all. Median
age at definitive surgery was 11 (range, 7–17) years with a median postoperative stay
of 9 (range, 7–12) days and a follow-up of 6 (range, 0.5–12) years. All children reported
markedly reduced episodes of pain postprocedure. One developed diabetes mellitus,
while three had exocrine deficiency (fecal elastase < 200 µg/g) requiring enzyme supplementation.
The child with limited LPJ had symptomatic recurrence and required restenting and
further surgery to widen the anastomosis to become pain free.
Conclusion ERCP and stenting provide a therapeutic trial to assess possible benefit of a definitive
duct drainage procedure. LPJ—the modified Puestow operation was safe and complication-free
with good medium-term relief of symptoms. We were not able to identify a consistent
etiology-associated outcome.
Keywords
chronic pancreatitis - Puestow procedure - hereditary pancreatitis - ERCP
