Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence

Abstract

Introduction For the surgical management of chronic pancreatitis with an inflammatory pancreatic head mass, extended drainage operations such as Beger and Frey procedures were established in the 1980s as an alternative to resectional procedures like pancreaticoduodenectomy and as opposed to simple drainage operations such as lateral pancreaticojejunostomy, that is, the Partington procedure. With the relatively rapid adoption of the two procedures, it seems that the Partington procedure has become a thing of the past. Materials and methods The Partington procedure was reevaluated with regard to the historical aspects and its present status by a literature review. Results The results show that this procedure relieves chronic abdominal pain in 66-91% of patients with a mean follow-up of 3.5-9.1 years. It is important to note that this procedure is generally used for inflammatory disease left of the gastroduodenal artery and is specifically not used as the procedure of choice for inflammatory disease of the pancreatic head. Conclusion For patients with a dilated main pancreatic duct but without an inflammatory pancreatic head mass, the Partington procedure is still the procedure of choice, since it is technically simple to perform with a minimum of morbidity and mortality, preserving pancreatic endocrine and exocrine function. Because it is a relatively simple technique, the laparoscopic approach will be justified as a treatment of appropriate patients in the near future.

Functional and Medical Outcomes After Tailored Surgery for Pain Due to Chronic Pancreatitis

“…30,34 It is for this reason that some surgeons believe (minimal) resection should be part of any surgical procedure for CP, and it might explain the rapid and firm rise in popularity of the organ-sparing resection procedures. 35 A pancreatic head diameter of 4 cm or more is the threshold we use to decide for a local resection of the pancreatic head. 33 Patients with a pancreatic head smaller than this threshold are considered candidates for surgical drainage only.…”

Role of original and modified Frey's procedures in chronic pancreatitis

“…It is evident that not all patients with CP are suitable for the Partington procedure. It is specifically not used as the procedure of choice for inflammatory disease of the pancreatic head[11]. The principal cause of failure of the Puestow operation is the lack of adequate decompression of the proximal duct of Wirsung, as well as the uncinated and tributary ducts in the head of the pancreas[6].…”

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

“…Isaji in a review article says that pain relief is anywhere between 66 and 91 % after LPJ [21]. In comparison, our study had a pain relief in 100 % of population and 16 (57.1 %) had complete remission of pain on VAS.…”