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.
Department of Surgery and Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA. tjhoward@iupui.edu
Thomas J
TJ
Howard
Jeffrey S
JS
Browne
Nicholas J
NJ
Zyromski
Harish
H
Lavu
Marshall S
MS
Baker
Changyu
C
Shen
James A
JA
Madura
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