Operative treatment for chronic pancreatitis pain.
BACKGROUND
Management of pain is the most frustrating problem associated with chronic pancreatitis. Pain is progressive and difficult to quantify. Uncontrolled, it eventually destroys the patient's quality of life, leading to drug addiction.


METHODS
This study reports the results of 258 operations on 239 consecutive patients treated for pain related to chronic pancreatitis between 1969 and 1999. The operations performed were 42 pancreaticoduodenectomies, 48 side-to-side pancreaticojejunostomies, 68 distal pancreatectomies, 21 85% to 95% distal pancreatectomies, 70 cystenterostomies and 9 sphincteroplasties. Efforts were made to choose the operation most appropriate for the pathological conditions encountered in each patient. Results of treatment were satisfactory if patients were entirely relieved of pain and unsatisfactory if there was any residual pain. Presence or absence of pain was based on patient's own evaluation at the time of their last followup examination.


RESULTS
Results were overall satisfactory in 71% of patients after pancreaticoduodenectomy, 68% after side-to-side pancreaticojejunostomy, 69% after distal pancreatectomy; 69% after 85% to 95% distal pancreatectomy, 51% after cystenterostomy, and 44% after sphincteroplasty. The mean followup of patients was 4 y (range 0 to 23 y).


CONCLUSIONS
The cause of chronic pancreatitis is obscure. As a consequence, there have been few advances in the treatment of this condition. There are new techniques to resect the pancreas, but the results are little better than those obtained with older methods. Advances in the treatment of chronic pancreatic pain will come from knowledge concerning its cause. Discovery of mechanisms stimulating the pathways that lead to the perception of pain and methods for interruption of these mechanisms may provide new treatments.
Jordan
P H
PH
Department of Surgery, Baylor College of Medicine, The Veteran's Administration Medical Center, The Methodist Hospital, Houston, TX, USA.
Pikoulis
M
M
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004766:Enterostomy / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control* / Q000523:psychology; D010147:Pain Measurement; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods; D010195:Pancreatitis / Q000150:complications* / Q000601:surgery*; D018579:Patient Selection; D011788:Quality of Life; D013105:Sphincterotomy, Transduodenal / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome