Laparoscopic Approach Cuts Pancreatitis Complication Rates

Minimally invasive transplant surgery reduces operative times, length of stay, and promises quicker opioid independence for patients suffering from chronic pancreatitis (CP).

Developed at Johns Hopkins University (JHU, Baltimore, MD, USA), laparoscopic total pancreatectomy with islet cell auto transplantation (TPIAT) involves surgically removing the pancreas and reconstructing the gastrointestinal tract. While removing the pancreas often relieves the severe abdominal pain that accompanies CP, it also causes the patient to develop insulin-dependent diabetes. To counter this eventuality, islet cells from the diseased pancreas are isolated and injected into the patient’s liver.

To examine the feasibility of using a laparoscopic TPIAT approach in the treatment of CP, 32 patients were offered to undergo the procedure between January 1, 2013, and December 31, 2015. Of the 22 patients who eventually underwent laparoscopic TPIAT, two patients converted to an open procedure because of difficult anatomy and prior surgery. Average operating time was 493 minutes, average islet isolation took 185 minutes, and average length of hospital stay was 11 days. Pain and glycemic outcomes were recorded at follow-up visits every 3’6 months postoperatively.

The results showed that that laparoscopic TPIAT (compared to open TPIAT) resulted in shorter average operative time, islet isolation time, warm ischemia time, and length of stay. No patients experienced postoperative surgical site infection (SSI), hernia, or small-bowel obstruction, and none died. In all, 90% of the patients experienced a decrease or complete resolution of pain, with 60% no longer requiring opioid therapy. At one-year follow-up, 25% were insulin independent, 45% required 1-10 daily units (U/d) of insulin, 25% required 11-20 U/d, and one patient required greater than 20 U/d of basal insulin. The study was published on June 1, 2017, in JAMA Surgery.

“Chronic pancreatitis can be a very painful and debilitating condition. In an era of opioid addiction, performing a major operation through a minimally invasive technique can mean less pain for patients, reducing the need for opioids and their complications,” said senior author professor of surgery Martin Makary, MD, MPH. “Benefits of laparoscopic approaches can include vastly reduced risk of surgical wound and other infection, a quicker recovery, and better pain management.”

CP is an inflammation of the pancreas that does not heal or improve, eventually impairing a patient’s ability to digest food and make pancreatic hormones. The prevalence of CP is 50 people per 100,000, often developing between the ages of 30 and 40, and is more common in men than women. Symptoms include upper abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily, clay-colored stools. Patients who have CP may have a decreased quality of life due to pain and often require admission to the hospital for treatment of symptoms.

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