Outcome of surgery for chronic pancreatitis.
BACKGROUND
In patients with chronic pancreatitis, surgery is indicated for the management of intractable pain or for the treatment of complications.


METHODS
Sixty-three consecutive patients (49 men and 14 women of median age 40 (range 20-72) years) who had undergone surgery over an 8-year interval for chronic pancreatitis were studied. The mortality and morbidity rates associated with surgery were assessed and quality of life was reviewed based on relief of symptoms, analgesic use, employment and long-term sequelae.


RESULTS
Forty-four patients (70 per cent) had alcoholic chronic pancreatitis. In 60 patients the principal indication for surgery was intractable pain. Eighteen patients had a duodenum-preserving resection of the pancreatic head (Beger operation); the other surgical procedures were Whipple resection (15), left-sided resection (13), total pancreatectomy (seven), pseudocystjejunostomy (five), pancreaticojejunostomy (one) and bypass procedures (four). The median inpatient stay was 12 days; 23 patients had postoperative complications including one death (2 per cent). There was improved pain control (P < 0.001), a reduction in opiate analgesia use, increase in percentage weight gain (P < 0.01 at 2 years) and return to employment following surgery. Although there was an increase in diabetes mellitus and need for enzyme supplementation these were easily controlled.


CONCLUSIONS
Surgery is an effective treatment in carefully selected patients with chronic pancreatitis but must be tailored to the pattern of disease in each individual.
Evans
J D
JD
Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Wilson
P G
PG
Carver
C
C
Bramhall
S R
SR
Buckels
J A
JA
Mayer
A D
AD
McMaster
P
P
Neoptolemos
J P
JP
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods; D010195:Pancreatitis / Q000601:surgery*; D011182:Postoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome
D000700:Analgesics