Five to Twenty Year Followup after Surgery for Chronic Pancreatitis in 748 Patients

Abstract

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.

Natural Course of Chronic Pancreatitis

“…Although continued alcohol abuse distinctly worsens the effect of surgical treatment [41][42][43], it is still difficult to determine whether a postoperative deterioration results from chronic pancreatitis, or from continued alcohol abuse, or from the surgical treatment.…”

Outcome After Lateral Pancreaticojejunostomy for Chronic Pancreatitis

“…Fifteen patients died within 5 years (68%), 6 within 10 years (27%), and 1 after (1), and malnutrition and renal failure (1). In four patients, complications of chronic pancreatitis in the absence of documented alcohol abuse were considered the main cause of death, including progression of the pancreatic inflammation (1), diabetes (2), and mesenteric ischemia (1). Late complications of the operation included a strangulated small bowel obstruction with sepsis secondary to adhesions, and postsplenectomy sepsis.…”

“…Late complications of the operation included a strangulated small bowel obstruction with sepsis secondary to adhesions, and postsplenectomy sepsis. The remaining 9 patients died from other causes, including myocardial infarction (4), renal failure (2), cancer (1), sepsis ofunknown origin (1), and unknown (1). We used the Partington-Rochelle modification for LPJ in all cases."…”

Post-Operative Outcome in Patients Who Have Undergone Lateral Pancreaticojejunostomy for Chronic Pancreatitis

“…Prevalence of Endocrine and Exocrine insufficiences post-op was comparable with Leger's study. (7) (Table 12) Point to be noted was that it was a uniform finding that in all pre-existing diabetics, the required dose of hypoglycemics was decreased post-surgery, a finding also shared by Izbicki et al (17). However the exocrine function didn't improve post surgery.…”

“…The study by Leger et al (7) also had a mean age of 39.6 years. Pancreatitiswasmore common in males, a uniform finding in all studies.…”