Follow-Up Results of Surgical Treatment in Chronic Pancreatitis

Abstract

Between 1968 and 1981, 138 patients (101 male and 37 female) with a mean age of 38 years were operated on for chronic pancreatitis at the Department of General Surgery, University of Göttingen. Pathogenetic factors were alcohol abuse in 65%, biliary diseases in 14% and unknown in 20%. Surgical therapy included 51 resections (37%) (4 total pancreatectomies, 24 Whipple’s procedures and 23 left pancreatectomy). Drainage operations were performed in 68 patients (49%) (24 pancreaticojejunostomies and 44 cystojejunostomies). Intervention of neighboring organs were performed 23 times. The mean follow-up period was 10 years (4–14 years), the late mortality rate in drainage operations (15 and 19%) was twice as high as after resection procedures (7.5%). Recurrences occurred in 16 % after resections but in 41 % after drainage operations. Latent or manifest diabetes was observed in 21 % after drainage operations but in 63% in the resection group. From these data we conclude that both alcohol withdrawal and the type of planned operations are important factors in the prognosis of chronic pancreatitis.

Pancreaticoduodenectomy (Whipple resection) in the treatment of chronic pancreatitis

“…As indicated earlier, the operative mortality for pancreaticoduodenectomy for chronic pancreatitis has continued to fall. Table 6 [1][2][3][4][5][6][7] summarizes 465 patients reported in the period from 1987 to 1989. In this series, including 8 reports, only 3 series described fatalities, 5 of the smaller series reflecting a zero mortality rate.…”

Surgical management of chronic pancreatitis on the continent of Europe

“…The effect of the operation on pancreatic pain was generally regarded as excellent. The incidence of development or aggravation of diabetes ranged from 40% according to Van Kemmel and associates [21] and to Gall [36] to 57% according to Servais and colleagues [19] and to Kohler and co-workers [17]. The most frequently discussed problem remains long-term mortality which, in some series ofpancreaticoduodenectomy, is over 40%.…”

“…The operative mortality rates of these 2 procedures are not very different. According to Kestens and associates [20] and to Kohler and colleagues [17], their effects on endocrine and exocrine functions of the pancreas do not differ significantly. In some series, the long-term survival rate is higher after drainage than after resection, but this point remains controversial.…”

“…The following data appear to be constant in all European series. As shown in Table 1 [15][16][17][18][19][20], over 80% of patients are male and the mean age at the time of operation is around 40 years. Abdominal pain is almost always the main symptom; its incidence is over 80%, justifying the operation in 30-80% of cases [12].…”

“…Incidence of compression of the bile duct is estimated at 10-53%, depending on whether the criteria adopted are biological, radiologic, or clinical. Duodenal stenosis is less frequent, ranging from 2.8% in the experience of Kohler and associates [17] to 13% in the series of the A.F.C. [12].…”