title: Long-term follow-up in small duct chronic pancreatitis: A plea for extended drainage by "V-shaped excision" of the anterior aspect of the pancreas.
abstract: BACKGROUND
  A pancreatic duct diameter (PDD) ranging from 4 to 5 mm is regarded as "normal." The "large duct" form of chronic pancreatitis (CP) with a PDD >7 mm is considered a classic indication for drainage procedures. In contrast, in patients with so-called "small duct chronic pancreatitis" (SDP) with a PDD <3 mm extended resectional procedures and even, in terms of an "ultima ratio," total pancreatectomy are suggested.
  
  
  METHODS
  Between 1992 and 2004, a total of 644 patients were operated on for CP. Forty-one prospectively evaluated patients with SDP underwent a new surgical technique aiming at drainage of the entire major PD (longitudinal "V-shaped excision" of the anterior aspect of the pancreas). Preoperative workup for imaging ductal anatomy included ERCP/MRCP, visualizing the PD throughout the entire gland. The interval between symptoms and therapeutic intervention varied from 12 to 120 months. Median follow-up was 83 months (range, 39-117 months). A pain score as well as a multidimensional psychometric quality-of-life questionnaire was used.
  
  
  RESULTS
  Hospital mortality was 0%. The perioperative (30 days) morbidity was 19.6%. Postoperative, radiologic imaging showed an excellent drainage of the entire gland and the PD in all but 1 patient. Global quality-of-life index increased in median by 54% (range, 37.5%-80%). Median pain score decreased by 95%. Twenty-seven patients (73%) had complete pain relief. Sixteen patients (43%) developed diabetes, while the exocrine pancreatic function was well preserved in 29 patients (78%).
  
  
  CONCLUSIONS
  "V-shaped excision" of the anterior aspect of the pancreas is a secure and effective approach for SDP, achieving significant improvement in quality of life and pain relief, hereby sparing patients from unnecessary, extended resectional procedures. The deterioration of exocrine and endocrine pancreatic functions is comparable with that observed during the natural course of the disease.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
authors.forename: Emre F
authors.initials: EF
authors.lastname: Yekebas
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
authors.forename: Human
authors.initials: H
authors.lastname: Honarpisheh
authors.forename: Guellue
authors.initials: G
authors.lastname: Cataldegirmen
authors.forename: Christian R
authors.initials: CR
authors.lastname: Habermann
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.forename: Bjoern C
authors.initials: BC
authors.lastname: Link
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Lars
authors.initials: L
authors.lastname: Wolfram
authors.forename: Oliver
authors.initials: O
authors.lastname: Mann
authors.forename: Michael
authors.initials: M
authors.lastname: Bubenheim
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts; D010193:Pancreaticojejunostomy; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome