Shaheed Procedure: An Innovative Technique in the Management of Chronic Pancreatitis Calculous
Md. Shahidur Rahman
Hepatic and Biliary Surgery, Bangabandhu Shiekh Mujib Medical University, Bangladesh.
Syeed Mehbub Ul Kadir *
Sheikh Fazilatunnesa Mujib Eye Hospital and Training Institute, Bangladesh.
Md. Saifur Rahman
Department of Surgery, 250 Bed District Hospital, Magura, Bangladesh.
Amena Sharmeen
Northern Intrnational Medical College, Dhaka, Bangladesh.
Zefrin Akter
Bangabandhu Sheikh Mujib Medical University, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Aim: To describe a new technique (Shaheed Procedure, single anastomosis-based side-to-side lateral pancreatojejunostomy) instead of two anastomoses of Roux-en-Y pancreatic jejunostomy for chronic pancreatitis calculous.
Methods: The Prospective longitudinal study was carried out in three tertiary-level hospitals in Bangladesh from 2010 to 2018. All the cases were diagnosed as chronic calculous pancreatitis with a dilated central pancreatic duct. The duct diameter is 6mm and above. The commonest investigation was ultra-sonography, and ERCP was carried out in all cases. The patients were subjected to surgery only when their pain was intractable and not responding to analgesics. A single anastomosis-based Pancreatic-Jejunostomy was made for all cases instead of the two-step anastomoses of Roux-en-Y pancreatic-jejunostomy. Postoperative assessment of their clinical and biochemical features was done every three months.
Description of Technique: The transverse colon with mesocolon is lifted upwards after incision. A longitudinal incision was made and exposed the whole length of the Pancreas. The anastomosis was made at the antero-inferior surface of the Pancreas, the most dependent part. The jejunal loop selected for anastomosis is 56 cm away from the DJ flexure, held by two Babcock forceps. No Rouxen Y anastomosis.
Results: A total of 146 cases were evaluated in this study, including 76 male and 70 female patients. Age ranges from 15 years to 54 years. Complications like abdominal bleeding and anastomotic leakage did not happen in the postoperative period. Long-time follow-up was six years, and short-time follow-up was only one month. The total operating time is 90 to 120 minutes, with minimal blood loss. No recurrence and postoperative complications were observed in the follow-up time. The pain was relieved in 96% of cases postoperatively. Single anastomosis, shorter operating time, less morbidity with zero mortality rate.
Conclusion: The new technique is a new option with better outcomes in pancreatic calculi management's drainage and decompression procedure.
Keywords: Chronic calculous pancreatitis, new technique, single anastomosis, pancreatojejunostomy, shaheed procedure