Hopkins surgeons develop minimally invasive surgery for chronic pancreatitis

Johns Hopkins surgeons have developed a minimally invasive surgery to address chronic pancreatitis, a painful condition that can be remedied by removing the pancreas.

While some cases of chronic pancreatitis are caused by alcoholism, most come from a genetic mutation. But sufferers are often written off as alcoholics or drug addicts because they use opioids to manage the pain, said Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine.

Many of them, often men in their 20s and 30s, can have trouble eating and holding down a job because they’re in severe pain.

"The people that come to us with a gene mutation that is no fault of their own have already been accused multiple times of being alcoholic and have been told that there's nothing to be done and that they're drug-seeking patients," Makary said. "Many of these patients have had their lives ruined by this disease."

But the surgery to remove the pancreas to fix chronic pancreatitis can be very painful itself. The minimally invasive surgery Makary and the Hopkins team developed can cause less pain, require fewer opioids to manage post-operative pain and produce fewer complications, Makary said.

A report on their findings was published in the June edition of JAMA Surgery.

The approach is called laparoscopic total pancreatectomy with islet cell autotransplantation. Surgeons take islet cells from the pancreas and insert them into the liver, where they can create insulin and help control blood sugar for five to 10 years before wearing out.

Surgeons make a keyhole incision in the patient's bellybutton, then remove organs such as the spleen and the gallbladder that share blood flow with the pancreas. The pancreas is then removed, and the other organs are placed back in the abdominal cavity.

Traditionally, the abdominal cavity is opened with a long incision.

The Hopkins team performed the surgery on 20 patients over three years. Almost all reported less or no pain after six months. Sixty percent no longer needed opioids to manage pain.

The minimally invasive surgery technique appeared to have benefits over traditional surgery approaches, said Jonathan S. Bromberg, a professor of surgery and microbiology and immunology and the vice chair for research at the University of Maryland School of Medicine.

"It looked like they had a very good success rate in treating pain here," he said. "Those are really good solid results. It's not 100 percent, but I think that's the nature of this disease."

Patients who have their pancreas removed end up developing diabetes, a trade off that many will accept in exchange for relief from pain. They also need enzyme tablets when they eat to replace digestive enzymes made by the pancreas.

"While the operation is not a perfect solution because most patients do become diabetic eventually, it does offer them an option to trade a very debilitating condition for mild or severe diabetes," Makary said.

Makary said the primary goal of the surgery would be to reduce patients' dependence on opioids. He said such a goal was important as Maryland and the country battles rising opioid addiction and overdose rates.

"With an increase in recognition that opioids are a major problem, Maryland in particular has record high rates of opioid use," he said. "I think the most important aspect of minimally invasive surgery is it reduces the need for opiates."

cwells@baltsun.com

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