New surgical technique for pancreatic lithotripsy without coring-out
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CASE REPORT
New surgical technique for pancreatic lithotripsy without coring‑out Tatsuaki Sumiyoshi1 · Kenichiro Uemura1 · Naru Kondo1 · Kenjiro Okada1 · Shingo Seo1 · Hiroyuki Otsuka1 · Masahiro Serikawa2 · Yasutaka Ishi2 · Shinya Takahashi1 Received: 30 July 2020 / Accepted: 18 August 2020 © Japanese Society of Gastroenterology 2020
Abstract The Frey procedure, which involves longitudinal pancreaticojejunostomy with coring-out of the pancreatic head, is considered the ideal surgical procedure for chronic pancreatitis with pancreas head stone. Long-term relief from abdominal pain after the Frey procedure was reported to reach about 90%, and this is the most common surgical procedure for chronic pancreatitis in Japan. However, coring-out has the potential risk of severe complications such as bile duct injury, pancreatic fistula, and postoperative hemorrhage. Therefore, we introduce a new lithotripsy technique using laparoscopic coagulation shear without coring-out. Keywords Chronic pancreatitis · Frey procedure · Lithotripsy · Laparoscopic coagulation shear
Introduction Most common surgical procedure for chronic pancreatitis is coring-out of the pancreas head and pancreaticojejunostomy, termed as the Frey procedure in Japan [1–6]. This procedure was reported to be effective in relieving the abdominal symptoms of pancreatitis over a long term; however, coring-out has the potential risk of severe complications such as bile duct injury, pancreatic fistula, and postoperative hemorrhage. Therefore, we introduce a new lithotripsy technique using laparoscopic coagulation shear (LCS) without coring-out.
Case report A 61-year-old man with a history of alcohol abuse suffered frequent diarrhea and refractory abdominal pain for over 10 years and was referred to our hospital. His
* Tatsuaki Sumiyoshi umk@hiroshima‑u.ac.jp 1
Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1‐2‐3 Kasumi, Minami‐ku, Hiroshima 734‐8551, Japan
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
2
laboratory tests showed slightly elevated serum levels of liver enzymes (glutamic oxaloacetic transaminase 38 U/L, glutamic pyruvic transaminase 57 U/L, and alkaline phosphatase 338 U/L). Tests results for amylase, C-reactive protein and carbohydrate 19–9 were within the normal range. Contrast-enhanced computed tomography (CT) showed a 3.6 cm-sized blocky stone in the pancreas head and dilated left-sided main pancreatic duct (MPD) (Fig. 1). Endoscopic retrograde cholangiopancreatography (ERCP) showed that the MPD was obstructed by the pancreas head stone and the common bile duct was curved and slightly narrowed due to the compression of the stone (Fig. 1b). He was diagnosed as having chronic pancreatitis and pancreas head stone, and extracorporeal shock wave lithotripsy was administered two times. However, the pancreas head stone showed no shrinkage, and surgery was planned. At laparotomy, severe chronic inflammat
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