Outcome After Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Abstract

ObjectiveTo assess the outcome of lateral pancreaticojejunostomy in patients with chronic pancreatitis. Summary Background DataChronic fibrocalcific pancreatitis associated with pancreatic ductal dilation and chronic pain has been managed successfully with lateral pancreaticojejunostomy. Early results, measured by pain relief and postoperative morbidity and mortality, have been excellent; however, long-term followup and overall outcome has been less clearly defined in these patients. MethodsThe outcome of 85 patients who had lateral pancreaticojejunostomy was assessed by reviewing hospital inpatient and outpatient records and conducting patient telephone interviews. ResultsOf 62 patients who were alive at follow-up, health status was characterized as good in 24%, fair in 31 %, and poor in 45%. Alcohol abuse continued in 42% of patients, whereas narcotic use continued in 35%, insulin use continued in 23%, and pancreatic enzyme supplementation continued in 34%. Rehospitalization for recurrent attacks of pancreatitis and pain was necessary in 40% of patients. Six patients required subsequent operations for complications of chronic pancreatitis. Death occurred in 22 patients (26%) and resulted from continued alcohol abuse, progression of chronic pancreatitis, or late complications of the operation in more than one half the cases. ConclusionsAlthough lateral pancreaticojejunostomy provided pain relief, had a low morbidity rate, and no early postoperative deaths, long-term outcome was poor based on the patient's health status, continued alcohol and narcotic use, employment status, subsequent hospitalization to treat recurrent pancreatitis or its complications, subsequent operations required for complications of chronic pancreatitis, and postoperative deaths related to comorbid medical conditions or complications of chronic pancreatitis. 481

Evaluation of Pain Preoperatively and Postoperatively in Patients with Chronic Pancreatitis Undergoing Longitudinal Pancreaticojejunostomy

“…On literature, search complication rates have been between 4 and 8 % in various studies after a longitudinal pancreaticojejunostomy [17,18,27]. In the present study, only 3/28 (10.71 %) subjects had wound infections; there were two immediate postoperative deaths.…”

“…In comparison, our study had a pain relief in 100 % of population and 16 (57.1 %) had complete remission of pain on VAS. Many studied in the past have used the different tools to assess pain relief like the 5-point system suggested by Nealon and Thompson [16] and the health status scale by Adams et al [17]. These are either Ten subjects had VAS score 0 at both 1 and 6 months.…”

“…In this study, an attempt is made to analyze the preoperative risk factors and its influence on the postoperative results in LPJ. It is a proven fact that alcoholism and smoking are independent risk factors for CP [17,25,26]. Others like familial, trauma, pancreatic divisum, cassava intake, and drug intake were absent in the study group [3].…”

“…Studies have reported pain relief varying from 63 to 93 % from 1973 to 1999 after longitudinal pancreaticojejunostomy [9][10][11][12][13][14][15]. In the past, studies have used different tools to assess pain relief like the VAS, the 5-point system suggested by Nealon and Thompson [16], the health status scale by Adams et al [17], etc. Studies have concluded that continued use of alcohol progressively increases pain after surgery [16][17][18].…”

“…In the past, studies have used different tools to assess pain relief like the VAS, the 5-point system suggested by Nealon and Thompson [16], the health status scale by Adams et al [17], etc. Studies have concluded that continued use of alcohol progressively increases pain after surgery [16][17][18]. Two studies have concluded that the use of alcohol does not alter the pain but decreases survival [19,20].…”