Total pancreatectomy for chronic pancreatitis

Abstract

A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.

Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: A matched case-control study

“…4 Subsequent studies compared both techniques until fi nally the latter technique became established as the technical option for periampullary tumors. 5 During the 1970s and 1980s, patients needing surgery for chronic pancreatitis were subjected to aggressive pancreatectomies, [6][7][8][9] although some teams were critical of the postsurgical results. 9 To spare pancreatic tissue in these patients, Beger et al described cephalic pancreatectomy preserving the duodenum, namely, duodenum-preserving pancreatic head resection (DPPHR).…”

Pancreas Resection and Islet Autotransplantation for End-Stage Chronic Pancreatitis

“…19,[22][23][24][25][26][27][28] However, duodenal ischemia was an initial problem in three of the first four patients. This has since been overcome by using a pylorus-preserving technique of pancreas resection.…”

“…17,[22][23][24][25][26][27][28] After TP, up to a third of patients do not obtain adequate pain relief and will still require opiate-derived analgesia. 19 All patients become diabetic, with very labile diabetes; for patients who continue to have heavy alcohol ingestion, this may culminate in late death (40%).…”

Our Surgical Experience in Chronic Pancreatitis

“…Total pankreatektomi ciddi fonksiyon kaybı ve ağrısı olan veya diğer cerrahi işlemlere rağmen bulguları gerilemeyen hastalara uygulanabilen bir seçenektir. Şeker regulasyonunda ciddi bozulma bu yöntemin en önemli dezavantajı olarak kaydedilmektedir (16).…”