Abstract
The surgical management of chronic pancreatitis remains controversial. We have practised a selective approach to surgery using symptoms and endoscopic retrograde cholangiopancreatography (ERCP) as the indications for operation and the procedure performed. A total of 76 patients who underwent surgery for chronic pancreatitis over a 12 year period were reviewed. Of the patients, 24 (32%) had a Whipple's resection (WR), 41 (54%) distal pancreatectomy (DP) with drainage, and 11 (14%) had other procedures. Eleven patients had died. Hospital records were reviewed and of the 65 patients alive at follow-up, 51 (79%) were interviewed. Twenty-three patients (74%) who underwent DP reported either excellent or good general health compared with 7 (44%) who had WR (P = 0.04). However, there was no difference in general health between operative groups using visual analogue scales. There was no difference in pain at follow-up between DP and WR. Of patients interviewed, 88% felt that their pain was better than before operation and 25 (49%) had no pain at all. Diabetes developed more frequently after DP (P = 0.005) than after WR. Good results can be achieved by pancreatic resection when careful selection is exercised.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adams D. B., Ford M. C., Anderson M. C. Outcome after lateral pancreaticojejunostomy for chronic pancreatitis. Ann Surg. 1994 May;219(5):481–489. doi: 10.1097/00000658-199405000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BERENS J. J., BAGGENSTOSS A. H., GRAY H. K. Ductal changes in chronic pancreatitis. AMA Arch Surg. 1954 Jun;68(6):723–733. doi: 10.1001/archsurg.1954.01260050725001. [DOI] [PubMed] [Google Scholar]
- 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]
- Bockman D. E., Buchler M., Malfertheiner P., Beger H. G. Analysis of nerves in chronic pancreatitis. Gastroenterology. 1988 Jun;94(6):1459–1469. doi: 10.1016/0016-5085(88)90687-7. [DOI] [PubMed] [Google Scholar]
- Bradley E. L., 3rd Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg. 1987 Feb;153(2):207–213. doi: 10.1016/0002-9610(87)90816-6. [DOI] [PubMed] [Google Scholar]
- 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]
- Broome A. H., Eisen G. M., Harland R. C., Collins B. H., Meyers W. C., Pappas T. N. Quality of life after treatment for pancreatitis. Ann Surg. 1996 Jun;223(6):665–672. doi: 10.1097/00000658-199606000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Büchler M. W., Friess H., Müller M. W., Wheatley A. M., Beger H. G. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg. 1995 Jan;169(1):65–70. doi: 10.1016/s0002-9610(99)80111-1. [DOI] [PubMed] [Google Scholar]
- Delcore R., Rodriguez F. J., Thomas J. H., Forster J., Hermreck A. S. The role of pancreatojejunostomy in patients without dilated pancreatic ducts. Am J Surg. 1994 Dec;168(6):598–602. doi: 10.1016/s0002-9610(05)80129-1. [DOI] [PubMed] [Google Scholar]
- Ebbehøj N., Borly L., Bülow J., Rasmussen S. G., Madsen P. Evaluation of pancreatic tissue fluid pressure and pain in chronic pancreatitis. A longitudinal study. Scand J Gastroenterol. 1990 May;25(5):462–466. doi: 10.3109/00365529009095516. [DOI] [PubMed] [Google Scholar]
- Frey C. F., Bodai B. I. Surgery in chronic pancreatitis. Clin Gastroenterol. 1984 Sep;13(3):913–940. [PubMed] [Google Scholar]
- 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]
- Geenen J. E., Rolny P. Endoscopic therapy of acute and chronic pancreatitis. Gastrointest Endosc. 1991 May-Jun;37(3):377–382. doi: 10.1016/s0016-5107(91)70739-6. [DOI] [PubMed] [Google Scholar]
- Greenlee H. B., Prinz R. A., Aranha G. V. Long-term results of side-to-side pancreaticojejunostomy. World J Surg. 1990 Jan-Feb;14(1):70–76. doi: 10.1007/BF01670548. [DOI] [PubMed] [Google Scholar]
- Grodsinsky C. Surgical treatment of chronic pancreatitis. A review after a ten-year experience. Arch Surg. 1980 Apr;115(4):545–551. doi: 10.1001/archsurg.1980.01380040167030. [DOI] [PubMed] [Google Scholar]
- Isaksson G., Ihse I. Pain reduction by an oral pancreatic enzyme preparation in chronic pancreatitis. Dig Dis Sci. 1983 Feb;28(2):97–102. doi: 10.1007/BF01315137. [DOI] [PubMed] [Google Scholar]
- Jalleh R. P., Aslam M., Williamson R. C. Pancreatic tissue and ductal pressures in chronic pancreatitis. Br J Surg. 1991 Oct;78(10):1235–1237. doi: 10.1002/bjs.1800781028. [DOI] [PubMed] [Google Scholar]
- Keith R. G., Saibil F. G., Sheppard R. H. Treatment of chronic alcoholic pancreatitis by pancreatic resection. Am J Surg. 1989 Jan;157(1):156–162. doi: 10.1016/0002-9610(89)90439-x. [DOI] [PubMed] [Google Scholar]
- Leger L., Lenriot J. P., Lemaigre G. Five to twenty year followup after surgery for chronic pancreatitis in 148 patients. Ann Surg. 1974 Aug;180(2):185–191. doi: 10.1097/00000658-197408000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mannell A., Adson M. A., McIlrath D. C., Ilstrup D. M. Surgical management of chronic pancreatitis: long-term results in 141 patients. Br J Surg. 1988 May;75(5):467–472. doi: 10.1002/bjs.1800750522. [DOI] [PubMed] [Google Scholar]
- 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]
- Rattner D. W., Fernandez-del Castillo C., Warshaw A. L. Pitfalls of distal pancreatectomy for relief of pain in chronic pancreatitis. Am J Surg. 1996 Jan;171(1):142–146. doi: 10.1016/s0002-9610(99)80089-0. [DOI] [PubMed] [Google Scholar]
- Rossi R. L., Rothschild J., Braasch J. W., Munson J. L., ReMine S. G. Pancreatoduodenectomy in the management of chronic pancreatitis. Arch Surg. 1987 Apr;122(4):416–420. doi: 10.1001/archsurg.1987.01400160042004. [DOI] [PubMed] [Google Scholar]
- Sarles H., Sahel J. Pathology of chronic calcifying pancreatitis. Am J Gastroenterol. 1976 Aug;66(2):117–139. [PubMed] [Google Scholar]
- Sato T., Miyashita E., Yamauchi H., Matsuno S. The role of surgical treatment for chronic pancreatitis. Ann Surg. 1986 Mar;203(3):266–271. doi: 10.1097/00000658-198603000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sauerbruch T., Holl J., Sackmann M., Paumgartner G. Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study. Gut. 1992 Jul;33(7):969–972. doi: 10.1136/gut.33.7.969. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sawyer R., Frey C. F. Is there still a role for distal pancreatectomy in surgery for chronic pancreatitis? Am J Surg. 1994 Jul;168(1):6–9. doi: 10.1016/s0002-9610(05)80061-3. [DOI] [PubMed] [Google Scholar]
- Stone W. M., Sarr M. G., Nagorney D. M., McIlrath D. C. Chronic pancreatitis. Results of Whipple's resection and total pancreatectomy. Arch Surg. 1988 Jul;123(7):815–819. doi: 10.1001/archsurg.1988.01400310029004. [DOI] [PubMed] [Google Scholar]
- 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]
- Traverso L. W., Kozarek R. A. The Whipple procedure for severe complications of chronic pancreatitis. Arch Surg. 1993 Sep;128(9):1047–1053. doi: 10.1007/978-3-642-77437-9_45. [DOI] [PubMed] [Google Scholar]
- 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]
- 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]