Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1991 Nov;214(5):575–580. doi: 10.1097/00000658-199111000-00007

Total pancreatectomy with preservation of the duodenum and pylorus for chronic pancreatitis.

D W Easter 1, A Cuschieri 1
PMCID: PMC1358613  PMID: 1953110

Abstract

In an effort to minimize the nutritional complications that follow resection of the pancreas for severe chronic pancreatitis, the authors have performed a duodenum-preserving total pancreatectomy in eight patients for severe unremitting pain requiring large doses of opiate analgesia. Good relief of pain was obtained in six patients (75%), in whom the quality of life was undoubtedly improved. There were no problems with the control of diabetes after this procedure in any of these patients, and no patient has suffered any hypoglycemic attacks requiring medical treatment. This improved control of the diabetic state is probably related to a more physiologic state of the upper digestive tract, enabling a normal food intake. The authors found the operation to be technically difficult, however, and although there were no post-operative deaths, major complications were encountered in four patients. These consisted of postoperative bleeding requiring reoperation (two patients), sepsis, and a duodenal fistula, which progressed to stenosis.

Full text

PDF
575

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bagley F. H., Braasch J. W., Taylor R. H., Warren K. W. Sphincterotomy or sphincteroplasty in the treatment of pathologically mild chronic pancreatitis. Am J Surg. 1981 Apr;141(4):418–422. doi: 10.1016/0002-9610(81)90133-1. [DOI] [PubMed] [Google Scholar]
  2. Beger H. G., Büchler M., Bittner R. R., Oettinger W., Roscher R. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg. 1989 Mar;209(3):273–278. doi: 10.1097/00000658-198903000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Beger H. G., Krautzberger W., Bittner R., Büchler M., Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery. 1985 Apr;97(4):467–473. [PubMed] [Google Scholar]
  4. Braasch J. W., Vito L., Nugent F. W. Total pancreatectomy of end-stage chronic pancreatitis. Ann Surg. 1978 Sep;188(3):317–322. doi: 10.1097/00000658-197809000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cooper M. J., Williamson R. C., Benjamin I. S., Carter D. C., Cuschieri A., Linehan I. P., Russell R. C., Torrance H. B. Total pancreatectomy for chronic pancreatitis. Br J Surg. 1987 Oct;74(10):912–915. doi: 10.1002/bjs.1800741013. [DOI] [PubMed] [Google Scholar]
  6. DUVAL M. K., Jr Caudal pancreatico-jejunostomy for chronic relapsing pancreatitis. Ann Surg. 1954 Dec;140(6):775–785. doi: 10.1097/00000658-195412000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Frey C. F. Role of subtotal pancreatectomy and pancreaticojejunostomy in chronic pancreatitis. J Surg Res. 1981 Nov;31(5):361–370. doi: 10.1016/0022-4804(81)90075-5. [DOI] [PubMed] [Google Scholar]
  8. Gall F. P., Mühe E., Gebhardt C. Results of partial and total pancreaticoduodenectomy in 117 patients with chronic pancreatitis. World J Surg. 1981 Mar;5(2):269–275. doi: 10.1007/BF01658311. [DOI] [PubMed] [Google Scholar]
  9. Gough M. H. The surgical treatment of hyperinsulinism in infancy and childhood. Br J Surg. 1984 Jan;71(1):75–78. doi: 10.1002/bjs.1800710125. [DOI] [PubMed] [Google Scholar]
  10. Grant C. S., Van Heerden J. A. Anastomotic ulceration following subtotal and total pancreatectomy. Ann Surg. 1979 Jul;190(1):1–5. doi: 10.1097/00000658-197907000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hunt D. R., McLean R. Pylorus-preserving pancreatectomy: functional results. Br J Surg. 1989 Feb;76(2):173–176. doi: 10.1002/bjs.1800760223. [DOI] [PubMed] [Google Scholar]
  12. JOHNSTON I. D., WELBOURN R., ACHESON K. Gastrectomy and loss of weight. Lancet. 1958 Jun 14;1(7033):1242–1245. doi: 10.1016/s0140-6736(58)92108-1. [DOI] [PubMed] [Google Scholar]
  13. Kivilaakso E., Flemström G. Surface pH gradient in gastroduodenal mucosa. Scand J Gastroenterol Suppl. 1984;105:50–52. [PubMed] [Google Scholar]
  14. Lambert M. A., Linehan I. P., Russell R. C. Duodenum-preserving total pancreatectomy for end stage chronic pancreatitis. Br J Surg. 1987 Jan;74(1):35–39. doi: 10.1002/bjs.1800740112. [DOI] [PubMed] [Google Scholar]
  15. Leung J. W., Bowen-Wright M., Aveling W., Shorvon P. J., Cotton P. B. Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis. Br J Surg. 1983 Dec;70(12):730–732. doi: 10.1002/bjs.1800701212. [DOI] [PubMed] [Google Scholar]
  16. Linehan I. P., Lambert M. A., Brown D. C., Kurtz A. B., Cotton P. B., Russell R. C. Total pancreatectomy for chronic pancreatitis. Gut. 1988 Mar;29(3):358–365. doi: 10.1136/gut.29.3.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Linehan I. P., Russell R. C., Hobsley M. The dumping syndrome after pancreatoduodenectomy. Surg Gynecol Obstet. 1988 Aug;167(2):114–118. [PubMed] [Google Scholar]
  18. Mallet-Guy P. A. Late and very late results of resections of the nervous system in the treatment of chronic relapsing pancreatitis. Am J Surg. 1983 Feb;145(2):234–238. doi: 10.1016/0002-9610(83)90069-7. [DOI] [PubMed] [Google Scholar]
  19. Moossa A. R. Surgical treatment of chronic pancreatitis: an overview. Br J Surg. 1987 Aug;74(8):661–667. doi: 10.1002/bjs.1800740803. [DOI] [PubMed] [Google Scholar]
  20. Newman K. D., Braasch J. W., Rossi R. L., O'Campo-Gonzales S. Pyloric and gastric preservation with pancreatoduodenectomy. Am J Surg. 1983 Jan;145(1):152–156. doi: 10.1016/0002-9610(83)90182-4. [DOI] [PubMed] [Google Scholar]
  21. Prinz R. A., Greenlee H. B. Pancreatic duct drainage in 100 patients with chronic pancreatitis. Ann Surg. 1981 Sep;194(3):313–320. doi: 10.1097/00000658-198109000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sato T., Saitoh Y., Noto N., Matsuno K. Appraisal of operative treatment for chronic pancreatitis. With special reference to side to side pancreaticojejunostomy. Am J Surg. 1975 Jun;129(6):621–628. doi: 10.1016/0002-9610(75)90333-5. [DOI] [PubMed] [Google Scholar]
  23. Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg. 1980 Sep;192(3):306–310. doi: 10.1097/00000658-198009000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978 Jun;146(6):959–962. [PubMed] [Google Scholar]
  25. Trerotola S. O., Jones B., Crist D. W., Cameron J. L. Pylorus-preserving Whipple pancreaticoduodenectomy: postoperative evaluation. Radiology. 1989 Jun;171(3):735–738. doi: 10.1148/radiology.171.3.2717744. [DOI] [PubMed] [Google Scholar]
  26. Warshaw A. L., Torchiana D. L. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. Surg Gynecol Obstet. 1985 Jan;160(1):1–4. [PubMed] [Google Scholar]
  27. Williamson R. C., Cooper M. J. Resection in chronic pancreatitis. Br J Surg. 1987 Sep;74(9):807–812. doi: 10.1002/bjs.1800740919. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES