ROBOTIC LONGITUDINAL PANCREATICOJEJUNOSTOMY (PEUSTOW) FOR CHRONIC PANCREATITIS IN AN ADOLESCENT

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Author: American Pediatric Surgical Association
Published:
Specialties: Pediatric Surgery
Schools:
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From the APSA 2017 Annual Meeting proceedings

ROBOTIC LONGITUDINAL PANCREATICOJEJUNOSTOMY (PEUSTOW) FOR CHRONIC PANCREATITIS IN AN ADOLESCENT

Anna F. Tyson, MD, MPH, Daniel A. Bambini, MD, John B. Martinie, MD.

Carolinas Medical Center, Charlotte, NC, USA.

Purpose: A fifteen-year-old Hispanic girl presented with a brief history of nausea, vomiting and  severe abdominal pain. She  had  no prior episodes of pain, but reported a remote history of blunt abdominal trauma from a bicycle  handle injury. Workup revealed evidence of chronic  pancreatitis with diffuse calcifications throughout the pancreas and  a dilated, tortuous pancreatic duct.  This abstract describes robotic  longitudinal pancreaticojejunostomy for management of her disease.

Methods: After thorough and  appropriate preoperative workup,  the patient underwent robotic  longitudinal  pancreaticojejunostomy. This was  accomplished using  three  8mm and  two 12mm  ports. The gastrocolic omentum was  opened using  a vessel sealing device, and  the stomach was  suspended. The pancreatic duct  was  identified  using ultrasound and  opened using  monopolar scissors. A Roux limb was  created 20cm  distal to the ligament of Treitz and  brought retrocolic to form the pancreaticojejunostomy.

The side-to-side jejunal enteroenterostomy was  created using  a robotic  stapler and  the common enterotomy was  sutured closed. Finally, the longitudinal pancreaticojejunostomy was  sutured using  a series of running monofilament absorbable barbed sutures.

Results: The patient tolerated the procedure well. Amylase level from the surgically placed drain was  normal  after eating, and  the drain was  removed prior to discharge on postoperative day five. She  has  subsequently been seen in clinic and  is doing  well 3 months out from surgery. She  has  no pain with eating  and  has  returned to her normal activities.

Conclusions: Surgical  treatment of chronic  pancreatitis in children  is rare and  is difficult to perform  using  traditional  laparoscopic techniques. We conclude that totally robotic longitudinal  pancreaticojejunostomy is a safe  and  effective  option  for management of chronic  pancreatitis with a dilated  distal pancreatic duct  in appropriately sized  children. This minimally-invasive technique allows a faster  recovery and  improved cosmesis compared to a traditional  open approach.

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