Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis.
BACKGROUND
Resection and drainage operations achieve long-term pain relief in approximately 85% of patients with chronic pancreatitis (CP). In patients who develop recurrent pain, a few data exist on the long-term results of remedial operations.


METHODS
Over an 18-year period (1988-2006), 316 patients with CP had primary resection or drainage operations at our institution. Thirty-nine developed recurrent pain and were treated by a remedial resection or drainage operation. Patient demographics, time to symptom recurrence, radiographic anatomic abnormalities, type of remedial operation, postoperative morbidity, and long-term outcomes were analyzed.


RESULTS
Thirty-nine patients, 56% female with a mean age of 41 years (range 16-61 years) had either remedial resection: total pancreatectomy (TP; N = 8), pancreaticoduodenectomy (PD; N = 6), distal pancreatectomy (DP; N = 5), or drainage operation: duodenal preserving pancreatic head resection (DPPHR; N = 8), revision of pancreaticojejunostomy (N = 12). TP achieved pain relief in 88% with postoperative complications greater than or equal to grade III in 38% and diabetes in 100%. Drainage operations achieved pain relief in 67% of patients with postoperative complications greater than or equal to grade III in only 8%. Partial parenchymal resections (DPPHR, PD, DP) as a remedial procedure achieved pain relief <50% of the time.


CONCLUSIONS
Drainage procedures, when anatomically feasible, are the preferred reoperation to treat patients with recurrent pain after failed primary operation for chronic pancreatitis.
Howard
Thomas J
TJ
Department of Surgery and Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA. tjhoward@iupui.edu
Browne
Jeffrey S
JS
Zyromski
Nicholas J
NJ
Lavu
Harish
H
Baker
Marshall S
MS
Shen
Changyu
C
Madura
James A
JA
D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010180:Pancreatectomy / Q000379:methods; D016577:Pancreaticoduodenectomy / Q000379:methods; D010193:Pancreaticojejunostomy / Q000379:methods; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D016896:Treatment Outcome