Pancreatojejunostomy refers to those types of surgical interventions that carry a minimal percentage of risks or possible complications. They resort to her help when the victim was found and confirmed the presence of chronic pancreatitis.
In this scenario, the patient needs to ensure the free outflow of the pancreatic secretion of their small ducts. This can be done by anastomosing the dissected pancreas. If the intervention is carried out by an experienced gastroenterologist-surgeon, then the chances of a recurrence of the disease at the acute stage are reduced to almost zero.
Additional benefits of manipulation are the improvement of the digestion of incoming food, the neutralization of pain and the prevention of diabetes. The last point will especially appeal to those patients who have a predisposition to this disease due to genetic characteristics.
Preparatory stage
Longitudinal pancreatojejunostomy implies the mandatory passage of preliminary clinical trials. This allows you to level the risks of contraindications that were hidden during the primary or superficial laboratory study of the patient.
First of all, the specialist is obliged to draw up a detailed anamnesis of the victim, relying not only on his current complaints about feeling unwell. Be sure to look through his past records from the medical record, a survey is conducted on whether the closest relatives have similar problems.
Only after this is assigned the passage of laboratory tests. For this, both a standard package of tests, such as blood donation, and individual appointments, such as an ultrasound examination of the abdominal organs, are used. Most often, in order to be able to cover the full picture of a possible lesion, the victim is offered to undergo an x-ray not only of the stomach, but also of the adjacent duodenum.
Such foresight is designed to eliminate the possible risks of inflammatory processes in neighboring tissues, which is characteristic of a protracted old disease. To clarify the data, the stage of contrasting, or computed tomography, is often involved. The latter is also possible with the addition of a contrast stage.
The final stage is retrograde endoscopic cholangiopancreatography. The technique is provided for the doctor to see the diameter of the pancreatic duct.
Together, this will not only confirm the diagnosis, but also serve as a kind of navigator for the surgeon during the operation.
How is everything going?
All manipulations are carried out through a wide median laparotomy. In “translation” from medical terminology, this means a dissection of the abdominal wall.
First, the expert crosses the gastrocolic ligament, and the stomach takes it up. After that, the gland duct is punctured with a syringe. Through his needle, you need to take the contents of the organ, in order to then conduct another laboratory examination.
After dissection of the parenchyma, the lumen above the duct opens. To simplify the action, a scalpel is involved. When forming a loop of the small intestine, it is necessary to monitor its passage into the omental bag through the mesentery of the transverse colon.
The next stage involves dissection of the antimesenteric edge of the intestine, and then suture material is applied. It is necessary to sew through the lower part of the duct, as well as through the thickness of the gland and the upper part of the enterotomy opening.
During suturing, special clamps are used that hold the tissues for ease of operation. Additionally, it is necessary to carve out a part of the loop from the exact intestine.
The final combination involves tying first the lower seams, and then the upper ones in such a way that it turns out to freely cut off the hanging ends. The loop is sewn to the mesentery of the colon of the transverse type, and then the doctor performs drainage, choosing the anterior lower edge of the pancreas. The output comes through another incision. It remains only to suture the abdominal wall.
The manipulation is carried out exclusively under general anesthesia. Anesthesia drugs are administered intravenously.
Rehabilitation and possible complications
Depending on the stage of development of the disease, the success rate of the manipulation will depend. It will also depend on what exactly during the operation the surgeon will undertake, using the Roux method, or something else due to the anatomical anomalies of the patient.
Upon completion of the procedure, which allows to get rid of the obstruction in the pancreatic duct, the victim must remain under the supervision of the medical staff for a certain time. We are talking about inpatient recovery for the rehabilitation period.
Experts are unlikely to announce the exact length of stay in a hospital bed, since they will have to focus on the individual ability of the human body to recover. To make a clearer prognosis, data on the dynamics of recovery obtained during the delivery of regular tests, as well as taking into account possible complications, are used.
The list of the latter often includes only purulent-septic lesions. They are easy to avoid if you entrust the intervention to an experienced medical team with a good reputation.
To hasten your return to a relatively normal life, it is worth following the doctor’s prescriptions by taking enzymes, proteolytic drugs, and pancreatic extracts prescribed by a gastroenterologist.
The operation, along with a carefully thought out recovery plan, will quickly get the patient back on their feet. The only nuance here can only be cirrhosis of the liver, which is perhaps the only absolute contraindication to pancreatojejunostomy.