title: The natural history of chronic pancreatitis after operative intervention: The need for revisional operation.
abstract: For patients with chronic pancreatitis, duodenum-sparing head resections and pancreaticoduodenectomy are effective operations to relieve abdominal pain. For patients who develop recurrent symptoms after their index operation, the long-term management remains controversial.
  
  
  
  Between 2002 and 2014, patients undergoing operative intervention for chronic pancreatitis were identified retrospectively. Patients requiring reoperation after their index operation were reviewed.
  
  
  
  A total of 121 patients with chronic pancreatitis underwent an index operation. At a median time of 33 months, 85 patients underwent no further operative intervention, while 36 patients underwent reoperation. A reoperative procedure was completed with acceptable perioperative morbidity and blood loss. After a revision operation, 25% of patients became narcotic independent. Narcotic requirements decreased from 143 morphine equivalent milligrams per day (MEQ/d) to 80 MEQ/d, and 58% of patients required less than 50 MEQ/d. Insulin requirements were not increased from preoperative levels. Multivariate analysis demonstrated only narcotic requirement and exocrine insufficiency after the index operation to be predictive for the need for a revision operation.
  
  
  
  Our data demonstrate the following: (1) A significant number of patients undergoing duodenum-sparing head resections (26%) or pancreaticoduodenectomy (29%) required reoperation for recurrent abdominal pain; and (2) a revisional operation can be effective in relieving recurrent abdominal symptoms. Patients with recurrent symptoms should be considered for additional operative intervention.
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Vikrom K
authors.initials: VK
authors.lastname: Dhar
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Nick C
authors.initials: NC
authors.lastname: Levinsky
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Brent T
authors.initials: BT
authors.lastname: Xia
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.affiliation: Department of Gastroenterology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Milton T
authors.initials: MT
authors.lastname: Smith
authors.affiliation: Department of Gastroenterology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Sampath
authors.initials: S
authors.lastname: Poreddy
authors.affiliation: Department of Radiology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Kyuran
authors.initials: K
authors.lastname: Choe
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH. Electronic address: ahmadsy@uc.edu.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D000066491:Clinical Decision-Making; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000401:mortality*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome