Ergebnisse der operativen Behandlung der chronischen Pankreatitis mit besonderer Berücksichtigung der exokrinen und endokrinen Funktion

Abstract

Studies were undertaken in 40 patients with chronic pancreatitis six months to seven and a half years (mean 25 months) after operation, results being compared with pre-operative findings. Measurements included: exercise capacity, absence of pain, body weight, endocrine (36) and exocrine (25) pancreatic function. Almost all patients returned to full or only slightly impaired activity, were free of pain or had less pain and weight increase. Exocrine pancreatic function (secretin-pancreozymin test and faecal fat) was noted in 11 of 25 patients. In another 11 pre-operative progression was arrested. But endocrine function improved in only three of 36 and worsened in 13 (manifestation of subclinical diabetes in eight, worse glucose tolerance in five). The results justify a more active surgical approach in the treatment of chronic pancreatitis in order to save the patients from an often long and painful "burning out" of the disease on purely conservative treatment. Furthermore, exocrine pancreatic function, at least, is maintained or improved.

Appropriate pancreatic function tests and indication for pancreatic enzyme therapy following surgical procedures on the pancreas

“…Accordingly, in our series we also found postoperatively an improved exocrine pancreatic function when patients had shown preoperatively only mild-to-moderate exocrine pancreatic insufficiency [22].…”

“…Seventeen In our study on postoperative exocrine pancreatic function, we were able to perform a secretin-pancreozymin test and quantitative fecal fat analysis in 25 patients 25 months (mean) after surgery [22]. Eleven (44%) patients experienced postoperative improvement of exocrine pancreatic function after various operations, another 11 (44%), a standstill, and a deterioration was observed in only 3 (12%) patients.…”

“…In conclusion, experience with postoperative exocrine pancreatic function is limited, but indicates improvement [16,22]. Postoperative deterioration is more frequent after resective operations as compared to drainage procedures [19,26].…”

Follow-Up Results of Surgical Treatment in Chronic Pancreatitis

“…Since this type of operation does not alter islet cell mass, we suggest that deterioration of endocrine function of the pancreas may be related to the natural progression of the inflammatory disease, which of course includes destruction of islet cells [4,27], A higher aggravation of diabetes was reported by Sato et al [12], Little information is available on exo crine function. A previous study from our hospital [28] shows that drainage operation can delay (at least for some time) the progressive deteriorations of pancreatic function. We observed improvement to normal function in 30%, which may be due to improvement in pancreatic duct drainage and subsequent recovery of the inflamed gland [4,28], However, whether or not deterioration of pancreatic function can be influenced by operation is certainly dependent on preoperative function.…”

“…A previous study from our hospital [28] shows that drainage operation can delay (at least for some time) the progressive deteriorations of pancreatic function. We observed improvement to normal function in 30%, which may be due to improvement in pancreatic duct drainage and subsequent recovery of the inflamed gland [4,28], However, whether or not deterioration of pancreatic function can be influenced by operation is certainly dependent on preoperative function. When ex ocrine or endocrine insufficiency is already progressive, improvement cannot be expected.…”