Surgical treatment of obstructive pancreatitis.
BACKGROUND
Unlike chronic calcific pancreatitis, obstructive pancreatitis occurs as a consequence of an obstruction or stricture in the main pancreatic duct. The purpose of this paper is to identify the best method of surgical treatment for patients with obstructive pancreatitis.


METHODS
Retrospective analysis of 224 patients surgically treated for chronic pancreatitis during a 7-year period (1988 through 1994) identified 23 patients with obstructive pancreatitis. Patients were classified by surgical treatment into pancreaticoduodenectomy (five patients), side-to-side pancreaticojejunostomy (nine patients), or distal pancreatectomy (nine patients) groups and analyzed.


RESULTS
Despite similar demographics, patients treated with distal pancreatectomy had significantly better outcomes (seven of nine) than those treated with either pancreaticoduodenectomy (zero of four) or side-to-side pancreaticojejunostomy (two of eight) at a mean follow-up of 26 months (chi-squared, p = 0.009). Multivariate analysis revealed stricture location, cause of pancreatitis, maximal duct dilatation, exocrine insufficiency, or continued alcohol intake had no influence on surgical outcome in this series (p = 0.698, logistic regression analysis).


CONCLUSIONS
At 2 years of follow-up, distal pancreatectomy provided superior relief from pain and recurrent pancreatitis compared with pancreaticoduodenectomy or side-to-side pancreaticojejunostomy. Obstructive pancreatitis is best treated by distal rather than proximal pancreatic resection or drainage.
Howard
T J
TJ
Surgical Service, Roudebush Veterans Administration Medical Center, Indianapolis, Ind, USA.
Maiden
C L
CL
Smith
H G
HG
Wiebke
E A
EA
Sherman
S
S
Lehman
G A
GA
Madura
J A
JA
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000150:complications / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010183:Pancreatic Ducts / Q000473:pathology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010193:Pancreaticojejunostomy / Q000009:adverse effects; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome