Duodenum-preserving pancreatic head resection: long-term results

Abstract

Early and late results from 298 patients with chronic pancreatitis who were surgically treated by means of duodenum-preserving pancreatic head resection (DPPHR) were prospectively analyzed. The aim of this operative procedure is to treat complications of chronic pancreatitis caused by inflammatory enlargement of the pancreatic head by decompressing the common bile duct, the pancreatic duct, the duodenum, and the retropancreatic intestinal vessels. End points of the study were early and late postoperative outcome. The follow-up period ranged from 1 to 22 years with a median follow-up of 6 years. In-hospital mortality was 1%, postoperative morbidity was 28.5%, and the rate of repeat laparotomy was 5.7%. Diabetes mellitus developed early in the postoperative period in six patients (2%). After a median follow-up of 6 years, late mortality was 8.9%. In the late follow-up period 88% of our patients were completely free of pain or had infrequent episodes and 63% were able to return to work. DPPHR might be considered as an alternative surgical technique in the treatment of chronic pancreatitis if the dominant lesion is in the pancreatic head.

Pain management in chronic pancreatitis

“…In his series, the pain relief after 5 years was complete or improved in 87% of cases. There is also one randomized series of patients comparing the Beger and Frey procedure [86][87][88][89][90] , with no difference in decrease of pain, but less morbidity with the Frey procedure.…”

“…By contrast, resection of the pancreatic head by either a conventional or pylorus-preserving pancreaticoduodenectomy will provide pain relief in up to 85% of patients, even if the disease extends into the distal pancreas. In order to deal with these undesirable consequences of the Whipple procedure, surgeons turned to the pylorus preserving pancreaticoduodenectomy (PPPD) and the "Beger procedure" [88][89][90][91] . Russel [92] , in studying the results of preser vation of the duodenum in total pancreatectomy compared with those of standard pancreaticoduodenectomy, found no difference in pain relief between the results of the two operations.…”

Surgery for Chronic Pancreatitis

“…Procedure-related mortality varies from 0% to 2% and the morbidity between 15% and 54%. At 5 years of follow-up, pain relieve is noticed in around 80% of patients and endocrine as well exocrine functions are well preserved [37,[45][46][47]. In terms of QOL, 69% of patients were professionally rehabilitated and in 72% of patients the Karnofsky index was between 90% and 100% [46].…”

“…Head of the pancreas has been referred to as the 'pacemaker' of the disease [10][11][12]. Resectional procedures deal with the pancreatic head mass, and hence Whipple procedure (D) was employed for the treatment for CP in the past.…”

“…In terms of QOL, 69% of patients were professionally rehabilitated and in 72% of patients the Karnofsky index was between 90% and 100% [46]. Death rates in patients with CP who have undergone Beger procedure at 5 years of follow-up have been reported to be 9-12.6% [46,47], which is in contrast to the reported mortality of 20-35% in patients of CP without treatment who were observed over a period of 6-10 years [48][49][50]. This supports the long-term benefits of Beger procedure.…”