Duodenum-Preserving Resection of the Head of the Pancreas in Severe Chronic Pancreatitis

Abstract

In 128 patients with severe chronic pancreatitis and inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the pancreatic head was performed. Median post-operative hospitalization was 15.5 days, and the frequency of reoperation was 5.5%. One patient died during the early post-operative phase, and hospital mortality amounted to 0.8%. After a median follow-up period of 3.6 years (range of 7 months to 16 years), six of 127 patients died (late mortality of 4.7%). Seventy-seven per cent of the patients were completely free of abdominal pain, 67% returned to their former occupations. During the late follow-up period, the glucose metabolism was unchanged in 80.7% of the patients, in 13.7% it deteriorated, and in 5.5% it improved permanently; 80% of the patients experienced a marked increase in weight averaging 8.7 kg. Compared with the Whipple procedure, the duodenum-preserving resection of the head of the pancreas spares the patient with chronic pancreatitis a gastrectomy, duodenectomy, and resection of the extrahepatic biliary ducts. In terms of a subtotal resection, the limited operative intervention at the head of the pancreas and the preservation of the duodenum explain the low early and late postoperative morbidity and mortality.

Metabolic consequences of a 50% partial pancreatectomy in humans

“…It is, however, important to note that this study has evaluated only the immediate consequences of a partial pancreatectomy and that the long-term results of this intervention may be different. In line with this, previous studies in healthy humans who donated 50% of their pancreas to relatives with type 1 diabetes have revealed an increased risk of diabetes in the donors [10,40,41], and previous long-term follow-up studies in patients with chronic pancreatitis have alluded to a progressive increase in the incidence of diabetes subsequent to a partial pancreatectomy [16,[42][43][44]. The present studies have also identified high pre-operative BMI and fasting glucose levels as risk factors for post-operative deteriorations in glucose control.…”

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

“…Pancreatic resections encompass various operations including distal pancreatectomy, Whipple 21 , Puestow 22 , Frey 23 and Beger 24 procedures, and TP performed with or without IAT. Although current evidence shows that long-term pain-related outcomes are independent of the type of surgical procedure 25 , up to 40 per cent of patients require opioid analgesia within 12 months following TP 14 and all invariably develop diabetes mellitus.…”

Medical Management of Chronic Pancreatitis: What Can Physicians Do?

“…To date, several attempts have been made to evaluate the degree of pain in CP using different pain scales and protocols (e.g., a visual analogue scale) [28,29]. However, it is difficult to accurately evaluate pain intensity since the individual perception of pain varies among patients.…”