The impact of surgical strategies on outcomes for pediatric chronic pancreatitis.
OBJECTIVE
To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief.


METHODS
Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated.


RESULTS
Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7-20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included: longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2-5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006-0.57; OR 0.07; 95%, CI 0.01-0.89). However, these associations were not present in multivariate analysis.


CONCLUSIONS
In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.
Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Maria G
MG
Sacco Casamassima
Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Seth D
SD
Goldstein
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Jingyan
J
Yang
Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Colin D
CD
Gause
Department of Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Fizan
F
Abdullah
Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.
Avner
A
Meoded
Department of Surgery, Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Martin A
MA
Makary
Department of Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 501, St Petersburg, FL, 33701, USA. pc@jhmi.edu.
Paul M
PM
Colombani
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000601:surgery*; D016035:Pancreas Transplantation / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011336:Probability; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
Children; Chronic pancreatitis; Hereditary pancreatitis; Pancreas divisum