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.