Open Surgical Removal of Firmly Impacted Pancreatic Duct Stent: Two Case Report

Abstract

Background: Pancreatic stents are used for a variety of different pancreatic disorders: pancreatic duct stones, chronic pancreatitis, pancreatic strictures, unresectable pancreatic cancer, preventing POPF and post-ERCP pancreatitis, papillary adenoma. Conventionally the pancreatic duct stents placement is done by endoscopic transpapillary procedure, but recently there are increasingly more reports of feasibility of percutaneous image-guided pancreatic duct (PD) drainage and stenting, which appears to be a safe and effective procedures, but it should be noted that these procedures also are not without any complications and may have some adverse events. The potential complications and adverse events of pancreatic stents placement, exchange and removal are: stents migration and dislocation; stent-induced strictures; stents fragmentation during removal; obstruction and dysfunction due to mucosal hyperplasia; stents clogging and impaction and at last even the bowel perforation.

 Aim: To choose the optimal surgical management

Material and Methods: Two cases of firmly impacted pancreatic stents removal recently observed in our institution led us to report our experience of successful management of these particular cases.

Results: The postoperative course was uneventful; the patients were discharged from the hospital at 5-th p/o day and pancreatic duct drainage catheters were removed at 3-4 weeks after surgery.

Conclusion: Open transduodenal stents removal with lateral pancreaticojejunostomy to prevent the pancreatic duct restenosis seems to be the most optimal and effective surgical procedure of removal the firmly impacted pancreatic duct stents in these difficult cases, which therefore could be considered like a real alternative approach and “parachute” option after failed attempts of stents removal by endoscopic and radiological procedures.