Early versus late surgical drainage for obstructive pancreatitis in an experimental model.
BACKGROUND
Chronic pancreatitis (CP) is characterized by intractable abdominal pain, and pancreatic exocrine and endocrine dysfunction. This study investigated whether early surgical drainage of pancreatic duct obstruction leads to improved recovery of pancreatic function compared with late surgical drainage in an experimental model of chronic obstructive pancreatitis.


METHODS
Twenty-one piglets underwent pancreatic duct ligation and subsequent longitudinal pancreaticojejunostomy after 3 weeks (early drainage) or 6 weeks (late drainage), and drainage continued for 6 weeks. In controls with CP pancreatic duct ligation was continued for 12 weeks without a drainage procedure.


RESULTS
Histological pancreatitis scores decreased with early drainage (P = 0.005), but not with late drainage. Pancreatic secretion of amylase and lipase was restored after early but not late drainage (P = 0.003 and P = 0.048 respectively). Excretion levels of lipase were restored to near-baseline preligation levels after early drainage. Pancreatic endocrine function (glucose tolerance test) showed no insufficiency in either group.


CONCLUSIONS
In this model of early versus late surgical drainage of obstructive pancreatitis, histology grades and pancreatic exocrine function showed improvement in the early drainage group but no recovery in the late drainage group.
Lamme
B
B
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Boermeester
M A
MA
Straatsburg
I H
IH
van Buijtenen
J M
JM
Boerma
D
D
Offerhaus
G J A
GJ
Gouma
D J
DJ
van Gulik
T M
TM
D000681:Amylases / Q000378:metabolism; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D002908:Chronic Disease; D002918:Chymotrypsin / Q000378:metabolism; D003251:Constriction, Pathologic / Q000201:enzymology / Q000473:pathology / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005243:Feces / Q000737:chemistry; D005260:Female; D008026:Ligation; D008049:Lipase / Q000378:metabolism; D023421:Models, Animal; D010193:Pancreaticojejunostomy / Q000379:methods; D050500:Pancreatitis, Chronic / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D011312:Pressure; D013552:Swine; D013997:Time Factors
D001786:Blood Glucose; D008049:Lipase; D000681:Amylases; D002918:Chymotrypsin