Modified Partington's procedure for pancreaticojejunostomy in chronic pancreatitis.

BACKGROUND: Various techniques have been described for pancreaticojejunostomy for chronic pancreatitis. We prospectively evaluated a modification of Partington's procedure with Roux-en-Y anastomosis for chronic calculous pancreatitis. METHODS: From 1980 to 1994, 53 patients with chronic calculous pancreatitis (46 men, 7 women; aged 14-70 years, mean 38) underwent surgery by the modified technique and were followed up for 1-14 years. The inclusion criterion for this procedure was pancreatic duct dilated to greater than 7 mm. End-to-side pancreaticojejunostomy was done by fishmouthing the jejunal end to a required length and anastomosing it to the pancreatic duct which is opened along its whole length. The procedure was evaluated in terms of feasibility of anastomosis, time required for surgery, perioperative complications and postoperative results. RESULTS: There were no anastomotic leaks or obstructive bowel symptoms in the immediate postoperative period. Excellent pain relief was seen in 81% of cases, and substantial relief in 12.8%. Average weight gain in the postoperative period was 4.2 Kg. Endoscopic retrograde pancreatography six months after surgery showed patency of anastomosis with free flow of dye into the jejunal loop across the anastomosis. CONCLUSION: The modified Partington's procedure is easy to perform and functions well without any complications. Pain is relieved successfully in a majority of cases.

Adult Hirschsprung's disease.

Hirschsprung's disease in adulthood is a rare entity. We report Hirschsprung's disease in a 35-year-old woman who had absence of anorectal inhibitory reflex on manometric studies.