Impact of single layer reconstruction following surgery for chronic calcific pancreatitis: a retrospective analytical study

Background: Surgery is an effective treatment for chronic calcific pancreatitis (CCP), addressing intractable pain and complications. While many studies predict outcomes of various surgical procedures, few focus on the impact of reconstruction type. This retrospective study analyzed the outcomes of single-layer pancreaticojejunostomy (PJ) following surgery for CCP. Aim was to evaluate outcomes of single-layer PJ in CCP patients, focusing on complications, pain relief, exocrine insufficiency, and endocrine dysfunction, compared with historical controls. Methods: The study included 250 CCP patients treated at a tertiary care center in Chennai, India, from January 2011 to December 2024. Surgical ductal clearance and single-layer Roux-en-Y PJ using non-absorbable/delayed absorbable sutures were performed. Data on intraoperative parameters, postoperative complications, and follow-up assessments at 1, 2, and 3 months were analyzed. Primary outcomes included reductions in pancreatic fistula, bleeding, and infections. Secondary outcomes included operative time and duct size. Results: The median age was 38 years, with a male predominance (74%). Frey’s procedure was the most common (59.2%), and the mean operative time was 170 minutes. Complications included pancreatic fistulas (6.4%) and infections (9.6%), with a low mortality rate (0.4%). Postoperatively, 91% of patients achieved pain relief, and 64.4% of diabetics had improved glycemic control. Single-layer PJ showed shorter operative times than two-layer PJ with similar pain relief and blood loss. Complications decreased significantly (from 45% to 8%), alongside reduced postoperative pain scores. Conclusions: Single-layer PJ is a safe, effective reconstruction method for CCP, reducing surgical complexity and related complications.