November 12, 2014
Notes: Kusnierz-Cabala, Beata
Research Support, Non-U.S. Gov’t
Clin Lab. 2013;59(9-10):1003-8.
Author Address: Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland. email@example.com
Reference Type: Journal Article
Record Number: 4704Author: Laje, P. and Adzick, N. S.
Title: Modified Puestow procedure for the management of chronic pancreatitis in children
Journal: J Pediatr Surg
Short Title: Modified Puestow procedure for the management of chronic pancreatitis in children
Alternate Journal: Journal of pediatric surgery
ISSN: 1531-5037 (Electronic)
Accession Number: 24210198
Keywords: Abdominal Pain/etiology
Diabetes Mellitus, Type 1/etiology
Exocrine Pancreatic Insufficiency/etiology
Length of Stay/statistics & numerical data
Abstract: PURPOSE: To present our experience with the modified Puestow procedure in the management of children with chronic pancreatitis. METHODS: Retrospective chart review of patients treated between 2003 and 2012. RESULTS: Six patients underwent a modified Puestow procedure (lateral pancreaticojejunostomy) for the management of chronic pancreatitis, three females and three males. Four patients had hereditary pancreatitis (three with confirmed N34S mutation in the SPINK1 gene), one patient had chronic pancreatitis of unknown etiology, and one patient with annular pancreas developed obstructive chronic pancreatitis. The pancreatic duct was dilated in all cases, with a maximum diameter of 5 to 10mm. Median time between onset of pain and surgery was 4 years (range: 1-9). Median age at surgery was 7.5 years (range: 5-15). Median hospital stay was 12 days (range: 9-28). Median follow up was 4.5 years (range: 5 months to 9 years). All patients had temporary postoperative improvement of their abdominal pain. In two patients the pain recurred at 6 months and 2 years postoperatively and eventually required total pancreatectomy to treat intractable pain, 3 and 8 years after surgery. Two patients were pain free for two years and subsequently developed occasional episodes of pain. The two most recent patients are pain free at 1 year (obstructive chronic pancreatitis) and 5 months (hereditary pancreatitis) follow-up. Two patients developed type I diabetes mellitus 10 and 12 months postoperatively (one with hereditary and one with idiopathic chronic pancreatitis). CONCLUSION: We conclude that the modified Puestow procedure in children is feasible and safe. It seems to provide definitive pain control and prevent further damage to the pancreas in patients with obstructive chronic pancreatitis. However, in patients with hereditary pancreatitis, pain control outcomes are variable and the operation may not abrogate the progression of disease to pancreatic insufficiency.