Pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head: preoperative and postoperative functional assessment.
OBJECTIVE
In chronic pancreatitis patients with an inflammatory mass of the pancreatic head receiving pancreatoduodenectomy, postoperative quality of life, including nutritional status, has become important. Pre- and postoperative evaluation of pancreatic function is essential as an effective means of proper nutritional management of patients following pancreatoduodenectomy.


METHODS
Fifteen patients with chronic pancreatitis and inflammatory mass of the pancreatic head who had received standard pancreatoduodenectomy were enrolled in this investigation. All patients had their biliary and pancreatic ducts reconstructed according to Child's arrangement. Furthermore, all patients had smooth postoperative courses and were assessed for the pancreatojejunostomy by magnetic resonance cholangiopancreatography at least a month after the initial operation. Exocrine pancreas functions were clinically assessed with various clinical items and two indirect pancreatic function tests: the fecal elastase test and the Bentiromide test. Endocrine pancreas functions were assessed using serum C-peptide level, HbA1 level and the need for hypoglycemic therapy.


RESULTS
The results indicated that the pancreatojejunostomies of all patients are patent magnetic resonance cholangiopancreatography. All patients benefited from the selected symptom relief and various clinical parameters, including medications, dietary restrictions, body mass index and plasma albumin levels, experiencing pain relief and improved exocrine and endocrine functions.


CONCLUSIONS
Pancreatic function did not deteriorate after pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head, while quality of life was significantly improved.
Chen
Han-Ming
HM
Department of Surgery, Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei, Taiwan. ming1838@yahoo.com
Jan
Yi-Yin
YY
Chao
Tsu-Che
TC
Hwang
Tsann-Long
TL
Chen
Miin-Fu
MF
D000203:Activities of Daily Living / Q000145:classification*; D000328:Adult; D002908:Chronic Disease; D018752:Diet, Fat-Restricted; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000601:surgery; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010186:Pancreatic Function Tests; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D010195:Pancreatitis / Q000601:surgery*; D011183:Postoperative Complications / Q000178:diet therapy / Q000209:etiology*; D011788:Quality of Life