Surgery for chronic obstructive pancreatitis: comparison of end-to-side pancreaticojejunostomy with pancreaticoduodenectomy.
OBJECTIVE
Chronic obstructive pancreatitis usually manifests with intractable pain and recurrent episodes of chronic pancreatic inflammation. The side-to-side pancreaticojejunostomy is used for those patients with a large pancreatic duct. But for the patients with small pancreatic duct, the optimal surgical procedure needs to be evaluated. A prospective study was designed to compare the different results between distal pancreatectomy plus end-to-side pancreaticojejunostomy and pancreaticoduodenectomy.


METHODS
The patients were chosen prospectively and randomly to undergo either a distal pancreatectomy plus end-to-side pancreaticojejunostomy or pancreaticoduodenectomy in the last 3 years. Eighteen patients with chronic obstructive pancreatitis were randomly divided into two groups. Ten patients (group A) underwent distal pancreatectomy plus end-to-side and ductal to mucosal pancreaticojejunostomy, and the other 8 patients (group B) underwent pancreaticoduodenectomy were compared.


RESULTS
The operative time was significantly shorter and operative blood loss was less in group A. The postoperative follow-up of patients in group A had better outcome with increased body weight and no steatorrhea or diabetes mellitus, and all of them had complete pain relief.


CONCLUSIONS
We concluded that distal pancreatectomy with end-to-side pancreaticojejunostomy provided a better surgical treatment for the patients with chronic obstructive pancreatitis and small pancreatic duct.
Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
T L
TL
Hwang
H M
HM
Chen
M F
MF
Chen
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D010183:Pancreatic Ducts / Q000473:pathology; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D015430:Weight Gain