Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1987 Mar;205(3):240–245. doi: 10.1097/00000658-198703000-00004

Subtotal resection of the head of the pancreas combined with ductal obliteration of the distal pancreas in chronic pancreatitis.

R P Kerremans, F M Penninckx, J De Groote, J Fevery
PMCID: PMC1492707  PMID: 3827358

Abstract

Subtotal resection of the head of the pancreas combined with duct obliteration of the distal pancreas by prolamine was performed in 12 selected patients who had chronic alcohol-induced pancreatitis with most destruction in the proximal pancreas. The main indication for operation was intractable pain. There was no postoperative mortality but morbidity was high when no pancreaticojejunostomy was constructed. After a follow-up period of 32 months, lasting pain relief was obtained in 10 patients; pseudocyst formation occurred in three patients; calcification of the distal pancreas, absent before operation, was demonstrated in four of six patients; six of 11 nondiabetic patients became hyperglycemic either abruptly (1 patient) or progressively (5 patients); quality of life improved in most patients. This procedure preserves the stomach, duodenum, spleen, distal pancreas and common bile duct if possible. However, pancreatic ductal obliteration with prolamine does not prevent relapses of chronic pancreatitis.

Full text

PDF
240

Selected References

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

  1. Adloff M., Ollier J. C., Schloegel M. Les opérations de drainage dans le traitement des pancréatites chroniques. A propos de 81 cas. Chirurgie. 1985;111(4):371–377. [PubMed] [Google Scholar]
  2. Afroudakis A., Kaplowitz N. Liver histopathology in chronic common bile duct stenosis due to chronic alcoholic pancreatitis. Hepatology. 1981 Jan-Feb;1(1):65–72. doi: 10.1002/hep.1840010111. [DOI] [PubMed] [Google Scholar]
  3. Ammann R. W., Akovbiantz A., Largiader F., Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology. 1984 May;86(5 Pt 1):820–828. [PubMed] [Google Scholar]
  4. Ammann R. W., Largiadèr F., Akovbiantz A. Pain relief by surgery in chronic pancreatitis? Relationship between pain relief, pancreatic dysfunction, and alcohol withdrawal. Scand J Gastroenterol. 1979;14(2):209–215. doi: 10.3109/00365527909179872. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Beger H. G., Witte C., Krautzberger W., Bittner R. Erfahrung mit einer das Duodenum erhaltenden Pankreaskopfresektion bei chronischer Pankreatitis. Chirurg. 1980 May;51(5):303–307. [PubMed] [Google Scholar]
  7. Braasch J. W., Rossi R. L. Pyloric preservation with the Whipple procedure. Surg Clin North Am. 1985 Apr;65(2):263–271. doi: 10.1016/s0039-6109(16)43581-4. [DOI] [PubMed] [Google Scholar]
  8. Bradley E. L. Parapancreatic biliary and intestinal obstruction in chronic obstructive pancreatitis. Is prophylactic bypass necessary? Am J Surg. 1986 Feb;151(2):256–258. doi: 10.1016/0002-9610(86)90081-4. [DOI] [PubMed] [Google Scholar]
  9. Brinton M. H., Pellegrini C. A., Stein S. F., Way L. W. Surgical treatment of chronic pancreatitis. Am J Surg. 1984 Dec;148(6):754–759. doi: 10.1016/0002-9610(84)90431-8. [DOI] [PubMed] [Google Scholar]
  10. CANNON J. A. Experience with ligation of the pancreatic ducts in the treatment of chronic relapsing pancreatitis. Am J Surg. 1955 Aug;90(2):266–280. doi: 10.1016/0002-9610(55)90758-3. [DOI] [PubMed] [Google Scholar]
  11. Cameron J. L., Mehigan D. G., Broe P. J., Zuidema G. D. Distal pancreatectomy and islet autotransplantation for chronic pancreatitis. Ann Surg. 1981 Mar;193(3):312–317. doi: 10.1097/00000658-198103000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Eckhauser F. E., Knol J. A., Strodel W. E., Achem S., Nostrant T. Common bile duct strictures associated with chronic pancreatitis. Am Surg. 1983 Jul;49(7):350–358. [PubMed] [Google Scholar]
  13. Flautner L., Papp J., Tihanyi T., Pap A., Tulassay Z., Kollin E., Szécsény A., Joós A. Endoskopische Occlusionsbehandlung bei Patienten mit chronischer Pankreatitis. Chirurg. 1985 Jan;56(1):36–40. [PubMed] [Google Scholar]
  14. Flautner L., Tihanyi T., Szécsény A. Pancreatogastrostomy: an ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis. Am J Surg. 1985 Nov;150(5):608–611. doi: 10.1016/0002-9610(85)90446-5. [DOI] [PubMed] [Google Scholar]
  15. Frey C. F., Child C. G., Fry W. Pancreatectomy for chronic pancreatitis. Ann Surg. 1976 Oct;184(4):403–413. doi: 10.1097/00000658-197610000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gall F. P., Gebhardt C. Ein neues Konzept in der Chirurgie der chronischen Pankreatitis. Dtsch Med Wochenschr. 1979 Jul 13;104(28):1003–1006. doi: 10.1055/s-0028-1129026. [DOI] [PubMed] [Google Scholar]
  17. Gall F. P., Muhe E., Gebhardt C. Etude comparative de 117 duodéno-pancréatectomies subtotales et totales pour pancréatite chronique. Premiers résultats de la sclérose per-opératoire du pancréas caudal. Chirurgie. 1979;105(3):187–192. [PubMed] [Google Scholar]
  18. 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]
  19. Gebhardt C., Stolte M. Pankreasgang-Okklusion durch Injektion einer schnellhärtenden Aminosäurenlösung. Experimentelle Studie. Langenbecks Arch Chir. 1978 Oct 16;346(3):149–166. doi: 10.1007/BF01261238. [DOI] [PubMed] [Google Scholar]
  20. Gooszen H. G., Bosman F. T., van Schilfgaarde R. The effect of duct obliteration on the histology and endocrine function of the canine pancreas. Transplantation. 1984 Jul;38(1):13–17. doi: 10.1097/00007890-198407000-00003. [DOI] [PubMed] [Google Scholar]
  21. Gooszen H. G., van Schilfgaarde R., Frölich M., Van der Burg M. P. The effects of duct obliteration and of autotransplantation on the endocrine function of canine pancreatic segments. Diabetes. 1985 Oct;34(10):1008–1013. doi: 10.2337/diab.34.10.1008. [DOI] [PubMed] [Google Scholar]
  22. Greenlee H. B. The role of surgery for chronic pancreatitis and its complications. Surg Annu. 1983;15:283–305. [PubMed] [Google Scholar]
  23. Hoffmann E., Usmiani J., Gebhardt C. Die Ausschaltung der exokrinen Funktion des Pankreas als Behandlungskonzept der chronischen Pankreatitis. Dtsch Med Wochenschr. 1977 Mar 18;102(11):392–395. doi: 10.1055/s-0028-1104898. [DOI] [PubMed] [Google Scholar]
  24. Hogle H. H., Recemtsma K. Pancreatic autotransplantation following resection. Surgery. 1978 Mar;83(3):359–360. [PubMed] [Google Scholar]
  25. Hutson D. G., Levi J. U., Livingstone A., Zeppa R. Pancreatic duct ligation in the therapy of chronic pancreatitis. Am Surg. 1979 Jul;45(7):449–452. [PubMed] [Google Scholar]
  26. Idezuki Y., Goetz F. C., Lillehei R. C. Late effect of pancreatic duct ligation on beta cell function. Am J Surg. 1969 Jan;117(1):33–39. doi: 10.1016/0002-9610(69)90282-7. [DOI] [PubMed] [Google Scholar]
  27. Ink O., Labayle D., Buffet C., Chaput J. C., Etienne J. P. Pancréatite chronique alcoolique: relations de la douleur avec le sevrage et la chirurgie pancréatique. Gastroenterol Clin Biol. 1984 May;8(5):419–425. [PubMed] [Google Scholar]
  28. Jordan G. L., Jr, Strug B. S., Crowder W. E. Current status of pancreatojejunostomy in the management of chronic pancreatitis. Am J Surg. 1977 Jan;133(1):46–51. doi: 10.1016/0002-9610(77)90191-x. [DOI] [PubMed] [Google Scholar]
  29. Kerremans R., Penninckx F., De Groote J., Fevery J., Baert A. Subtotal pancreatic head resection combined with left pancreatic duct obstruction in chronic pancreatitis. Acta Gastroenterol Belg. 1985 Nov-Dec;48(6):603–606. [PubMed] [Google Scholar]
  30. Kondo T., Hayakawa T., Noda A., Ito K., Yamazaki Y., Iinuma Y., Okumura N., Sakakibara A., Mizuno R., Naruse S. Follow-up study of chronic pancreatitis. Gastroenterol Jpn. 1981;16(1):46–53. doi: 10.1007/BF02820424. [DOI] [PubMed] [Google Scholar]
  31. 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]
  32. Lippert H., Wolff H., Lorenz D., Wojczik H., Kühn F. Erfahrungen mit der Pankreasokklusion nach kephaler Duodenopankreatektomie. Zentralbl Chir. 1984;109(17):1112–1121. [PubMed] [Google Scholar]
  33. Little J. M., Stephen M., Hogg J. Duct obstruction with an acrylate glue for treatment of chronic alcoholic pancreatitis. Lancet. 1979 Sep 15;2(8142):557–559. doi: 10.1016/s0140-6736(79)91616-7. [DOI] [PubMed] [Google Scholar]
  34. Madding G. F., Kennedy P. A. Chronic alcoholic pancreatitis. Treatment by ductal obstruction. Am J Surg. 1973 May;125(5):538–541. doi: 10.1016/0002-9610(73)90133-5. [DOI] [PubMed] [Google Scholar]
  35. Madding G. F., Kennedy P. A., McLaughlin B. Obstruction of the pancreatic duct by ligature in the treatment of pancreatitis. Ann Surg. 1967 Jan;165(1):56–60. doi: 10.1097/00000658-196701000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Morrow C. E., Cohen J. I., Sutherland D. E., Najarian J. S. Chronic pancreatitis: long-term surgical results of pancreatic duct drainage, pancreatic resection, and near-total pancreatectomy and islet autotransplantation. Surgery. 1984 Oct;96(4):608–616. [PubMed] [Google Scholar]
  37. Nogueira C. E., Dani R. Evaluation of the surgical treatment of chronic calcifying pancreatitis. Surg Gynecol Obstet. 1985 Aug;161(2):117–128. [PubMed] [Google Scholar]
  38. Pap A., lautner L., Tihanyi T., Papp J., Szécsény A., Varró V. Pancreatic function after endoscopic and surgical occlusion of the pancreatic duct in patients with chronic pancreatitis. Endoscopy. 1985 Mar;17(2):60–63. doi: 10.1055/s-2007-1018458. [DOI] [PubMed] [Google Scholar]
  39. Prinz R. A., Aranha G. V., Greenlee H. B. Redrainage of the pancreatic duct in chronic pancreatitis. Am J Surg. 1986 Jan;151(1):150–156. doi: 10.1016/0002-9610(86)90025-5. [DOI] [PubMed] [Google Scholar]
  40. Rossi R. L., Braasch J. W., Nugent F. W., Silverman M. L., Beckmann C. F., Watkins E., Jr Segmental pancreatic autotransplantation for chronic pancreatitis. Am J Surg. 1983 Apr;145(4):437–442. doi: 10.1016/0002-9610(83)90036-3. [DOI] [PubMed] [Google Scholar]
  41. Schneider M. U., Lux G., Gebhardt C., Meister R., Pichl J., Heptner G., Knorr H., Rödle T., Domschke S., Domschke W. Therapeutische Pankreasgangocclusion bei chronischer Pankreatitis: klinische, exokrine und endokrine Konsequenzen bei 12monatiger Nachbeobachtung. Langenbecks Arch Chir. 1985;363(3):149–163. doi: 10.1007/BF01261289. [DOI] [PubMed] [Google Scholar]
  42. Scuro L. A., Vantini I., Piubello W., Micciolo R., Talamini G., Benini L., Benini P., Pederzoli P., Marzoli G., Vaona B. Evolution of pain in chronic relapsing pancreatitis: a study of operated and nonoperated patients. Am J Gastroenterol. 1983 Aug;78(8):495–501. [PubMed] [Google Scholar]
  43. Sutherland D. Pancreas and islet transplant registry data. World J Surg. 1984 Apr;8(2):270–275. doi: 10.1007/BF01655147. [DOI] [PubMed] [Google Scholar]
  44. Taylor R. H., Bagley F. H., Braasch J. W., Warren K. W. Ductal drainage or resection for chronic pancreatitis. Am J Surg. 1981 Jan;141(1):28–33. doi: 10.1016/0002-9610(81)90007-6. [DOI] [PubMed] [Google Scholar]
  45. Tosatti E., Valente U., Campisi C., Barabino C., Pozzati A. Segmental pancreas autotransplantation in man following total or near total pancreatectomy for serious recurrent chronic pancreatitis. Transplant Proc. 1980 Dec;12(4 Suppl 2):15–18. [PubMed] [Google Scholar]
  46. 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]
  47. Traverso L. W., Tompkins R. K., Urrea P. T., Longmire W. P., Jr Surgical treatment of chronic pancreatitis. Twenty-two years' experience. Ann Surg. 1979 Sep;190(3):312–319. doi: 10.1097/00000658-197909000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Van Bastelaere W., Derom F. Nieuwe trend in de heelkundige behandeling van chronische pancreatitis. Acta Chir Belg. 1983 Jan-Feb;83(1):60–64. [PubMed] [Google Scholar]
  49. Warshaw A. L. Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis. Am J Surg. 1985 Apr;149(4):563–569. doi: 10.1016/s0002-9610(85)80057-x. [DOI] [PubMed] [Google Scholar]
  50. Warshaw A. L., Popp J. W., Jr, Schapiro R. H. Long-term patency, pancreatic function, and pain relief after lateral pancreaticojejunostomy for chronic pancreatitis. Gastroenterology. 1980 Aug;79(2):289–293. [PubMed] [Google Scholar]
  51. White T. T., Keith R. G. Long term follow-up study of fifty patients with pancreaticojejunostomy. Surg Gynecol Obstet. 1973 Mar;136(3):353–358. [PubMed] [Google Scholar]

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

RESOURCES