One-hundred and forty eight patients operated upon for chronic pancreatitis were reviewed retrospectively in 5-20 year followup. Treatment was by drainage of the duct of Wirsung to adefunctionalized jejunal loop, distal pancreatectomy, pancreato-duodenectomy, splanchnicectomy with an operative mortality of 5%. Influence of clinical and anatomical data upon long term survival and symptomatic results was studied. Among Wirsungo-jejunostomy, distal or cephalic pancreatic resections, survival rates were highest with drainage of the duct of Wirsung and lowest with the pancreatoduodenectomy. Retrospectively, post-operative alcoholism appeared as the alone factor affecting long-term survival. Pancreatic insufficiency and liver cirrhosis were main causes of death. Among the survivors, the percentage of good symptomatic results ranged from (1/3) with splanchnicectomy to 6 of 8 after duodeno-pancreatic resection. Alcohol abstinence affected sypmptomatic results but at a lesser degree than for survival. It was observed that when left pancreatectomy was performed, drainage of the remaining duct of Wirsung into the jejunum significantly improved the good results from 40% to 75%. In the group of wirsungo-jejunostomies without pancreatic resection, it was found that pancreatic calcifications and a large diameter of the duct of Wirsung at the time of operation were favorable prognostic factors.

In patients with BDC, particular attention must be given to the associated intrahepatic bile duct dilatations. We propose a modification of Todani's classification to distinguish cystic, segmental, and fusiform dilatations of the intrahepatic biliary tree in type IV cysts. In patients with segmental left intrahepatic cystic dilatations, combined left liver lobectomy and extrahepatic cyst excision is suggested to decrease late postsurgical biliary complications.

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