Application value of superior mesenteric vascular right approach in duodenum-preserving pancreatic head resection for chronic pancreatitis with pancreatic head stones

Objective:To investigate the application value of superior mesenteric vascular right approach in duodenumpreserving pancreatic head resection for chronic pancreatitis with pancreatic head stones.
Methods: The retrospective descriptive study was conducted. The clinical data of 3 chronic pancreatitis patients with pancreatic head stones who were admitted to the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to May 2017 were analyzed. All the 3 patients underwent Beger procedure via superior mesenteric vascular right approach, dissecting the posterior tunnel of pancreatic neck and gradually cutting off the pancreatic neck close to the right side of superior mesenteric vein. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative pathological examination situations; (4) follow-up situations. follow-up was performed by outpatient examination up to December 2017, including abdominal pain, diarrhea, chills, fever, jaundice, blood glucose, liver function and tumor marker examination, and residual or recurrent stones by ultrasound, CT or MRI examination. Measurement data were represented as average (range).
Results: (1) Surgical situations: all the 3 patients underwent successful Beger procedure via superior mesenteric vascular right approach, including 1 combined with choledochal cyst resection, without perioperative death. The operation time, time of cutting off pancreatic neck and volume of intraoperative blood loss of 3 patients were 400 minutes (range, 360-480 minutes), 20 minutes (range, 15-25 minutes) and 117 mL (range, 50-200 mL) respectively. (2) Postoperative situations: time of initial out-of-bed activity, time to anal exsufflation and time for drinking intake were 4 days (range, 3-5 days), 3 days (range, 2-3 days) and 3 days (range, 2-4 days). One patient complicated with pancreatic fistula and gastroplegia was improved by abdominal drainage and symptomatic treatment and discharged with drainage-tube at 30 days postoperatively and removed drainage-tube at 47 days postoperatively. One patient with pancreatic fistula was improved by abdominal drainage and symptomatic treatment and discharged with drainage-tube at 28 days postoperatively and removed drainage-tube at 48 days postoperatively. One patient recovered steadily without complications and discharged at 13 days postoperatively after removal of drainage-tube. (3) Postoperative pathological examination showed that 3 patients were diagnosed as chronic pancreatitis complicated with stones of pancreatic head, including 1 along with choledochal cyst and mild atypical hyperplasia. (4) follow-up situations: 3 patients were followed up for 17-27 months with good general conditions and without abdominal pain, diarrhea, chills, fever or jaundice. Blood glucose was controlled well, and liver function and tumor marker were normal. There was no sign of residual and recurrent stones.
Conclusion:Beger procedure via superior mesenteric vascular right approach for chronic pancreatitis complicated with pancreatic head stones is safe and effective.