[The status of duodenum-preserving resection of the head of the pancreas in therapy of chronic pancreatitis].
OBJECTIVE
To evaluate the efficacy of duodenum-preserving resections of the head of the pancreas in the treatment of chronic pancreatitis this study was devised. So far studies on the natural course and the different therapeutic approaches have primarily focused on pain measurement in rough categories and hard data as mortality and morbidity. In this study the improvement of the quality of life was assessed to determine the therapeutic success of both procedures.


METHODS
In a prospective randomized study 24 patients underwent either Beger's (n = 11) or Frey's procedure (n = 13) so far. 15 patients suffered from distal common bile duct stenosis, 2 from segmental duodenal stenosis, 4 from segmental portal hypertension, and one from pancreato-pleural fistula. The quality of life questionnaire of the European Organization for Research and Treatment of Cancer was assessed before surgery and during follow-up. The multidimensional questionnaire incorporates functional scales (physical, cognitive, emotional, and social), symptom scales (fatigue, pain, dyspnea, loss of appetite, sleep disturbance, obstipation, diarrhea, nausea, and vomiting), and a global quality of life scale. Follow-up was 12 months in all patients.


RESULTS
There was no postoperative mortality in neither group. Postoperative morbidity was 17% (n = 2 in either group). This included one transitory common bile duct stenosis, one bronchopneumonia, and two postoperative bleedings which were treated conservatively. The pain index was reduced by 94% in the Beger- and 90% in the Frey group. The physical status, working ability, emotional and social functioning, and global quality of life score had significantly improved by 46%, 50%, 69%, 60%, and 67% in the Beger group and by 38%, 50%, 64%, 80%, and 67% in the Frey group.


CONCLUSIONS
The duodenum-preserving resections of the head of the pancreas according to Beger and Frey are equivalently safe and effective. Both techniques result in a significant improvement of the patients' quality of life.
Izbicki
J R
JR
Abteilung für Allgemeinchirurgie, Universitätskrankenhaus Eppendorf, Universität Hamburg.
Knoefel
W T
WT
Bloechle
C
C
Küchler
T
T
Kühn
R
R
Limmer
J C
JC
Broelsch
C E
CE
D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010180:Pancreatectomy / Q000379:methods*; D010195:Pancreatitis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D011788:Quality of Life
Stellenwert duodenumerhaltender Pankreaskopfresektionen in der Therapie der chronischen Pankreatitis.