Resection in chronic pancreatitis.
In the absence of ductal ectasia there is no adequate alternative to pancreatectomy for severe chronic pancreatitis. A personal series of 30 such patients operated upon between 1977 and 1984 included 16 with distal pancreatectomy, 6 with proximal pancreatectomy and 12 with total pancreatectomy; 4 patients progressed from distal to total resection after an interval of 15-28 months. The mean age was 39 years with a male preponderance of 77 per cent. The main aetiological agents were chronic alcoholism (63 per cent) and previous acute pancreatitis (23 per cent). One patient died after total pancreatectomy, giving a 30-day mortality rate for all resections of 3 per cent. Postoperative complications necessitated reoperation in 10 per cent, and there have been 5 late deaths (17 per cent). Among 27 patients followed for a median of 4.5 years, pain relief has been good in 16, fair in 8 and poor in 3 (11 per cent). Proximal pancreatectomy has proved superior to distal pancreatectomy with regard to analgesia and the avoidance of diabetes. Although technically demanding, total pancreatectomy has improved symptoms substantially in 9 of 10 patients surviving for a minimum of 18 months.
Williamson
R C
RC
University Department of Surgery, Bristol Royal Infirmary, UK.
Cooper
M J
MJ
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology; D010180:Pancreatectomy / Q000379:methods; D010195:Pancreatitis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation