Surgery for chronic pancreatitis: the tailored approach.
Considerable controversy exists regarding the optimal method of surgical relief of the pain of chronic pancreatitis. We previously made a retrospective study of 49 patients with chronic pancreatitis who were operated upon only for relief of pain. Those results indicated that patients who had an internal decompression had lower mortality, less morbidity, less postoperative pancreatic insufficiency, and better relief of pain (88% vs 76% improved). Since then, we have prospectively determined the operative treatment based upon the criteria outlined in that previous report. Seventeen patients had 19 operations (12 resections, seven internal drainage procedures). The patients' ages, duration of symptoms, and sex distribution are similar. Eight-five percent of patients with internal decompression had good to excellent relief of pain vs 60% of patients with resection. Pancreatic insufficiency occurred in 70% of patients who had resection and in only 14% of those who had drainage. Forty percent of patients who had resection had mild to severe postoperative morbidity vs 14% of those who had drainage. There was one postoperative death in the resection group. These preliminary results indicate that internal decompression in properly selected patients can provide superior relief of pain, with lower mortality, less morbidity, and less pancreatic insufficiency.
D000328:Adult; D002908:Chronic Disease; D004322:Drainage; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D059408:Pain Management; D010180:Pancreatectomy; D010195:Pancreatitis / Q000601:surgery*; D011446:Prospective Studies