Severe chronic cephalic pancreatitis: Use of partial duodenopancreatectomy with occlusion of the pancreatic duct in 289 patients

Abstract

Partial duodenopancreatectomy and occlusion of the remaining ductal system by Ethibloc to induce rapid exocrine atrophy for treatment of severe chronic cephalic pancreatitis was introduced in our department in January of 1978. Since then, this surgical procedure has been performed in a total of 289 patients. Postoperative morbidity was 12.2%, 5 pancreatic and 3 biliary fistulas occurred. Postoperative mortality was 1% and relapses of pancreatitis occurred in only 2.2% due to incomplete filling of ducts with Ethibloc. A total of 88.2% of patients became pain-free and symptomless, 10.8% voiced minor complaints, and 85.9% gained an averaged of 7.8 kg weight postoperatively. We conclude that Ethibloc occlusion is highly effective in inducing complete exocrine atrophy, thus abolishing the inflammatory process and preventing relapses of chronic pancreatitis and preserving the endocrine function from further impairment. This was demonstrated by biochemical assays during a 36-month follow-up in a prospective study in 23 of 289 patients. Our results compare favorably with and are superior to results from any other operative procedure for chronic cephalic pancreatitis. We consider partial duodenopancreatectomy combined with Ethibloc occlusion of the pancreatic duct the procedure of choice in the surgical treatment of severe chronic cephalic pancreatitis.

Outcome of Pancreaticoduodenectomy With Pylorus Preservation or With Antrectomy in the Treatment of Chronic Pancreatitis

“…Large published series, however, report successful weight maintenance or gain in more than 80% of patients after either operation. 12,13 Relief of pain after pancreaticoduodenectomy is another focus of debate. Information from the literature is commonly based on anecdotal experience of a single approach, often with small cohorts or inadequate follow-up information.…”

“…Information from the literature is commonly based on anecdotal experience of a single approach, often with small cohorts or inadequate follow-up information. [12][13][14][15][16][17] There are few studies comparing alternative surgical treatments.…”

“…12,13,[15][16][17] Many of these series include significant numbers of completion or total pancreatectomies, complicating the evaluation of cephalic pancreatectomy alone. 13,16 We judge our success in this experience to have been 65%, with no significant differences between the standard Whipple and PPPD groups.…”

Percutaneous sclerotherapy of a giant mediastinal lymphangioma

“…Ethibloc1 is highly efficient as a sclerosing agent and has been used in other indications, e.g. for renal artery embolisation and as a treatment of severe chronic pancreatitis by occlusion of the ductal system [7,8]. …”

Problems of Reconstruction during Pancreatoduodenectomy

“…(C) Occlusion of the main pancreatic duct by Neoprene® (a liquid synthetic rubber composed of polychloroprene homopolymer) [17, 18], Ethibloc® (a slowly hardening but degradable prolamine solution) [19]and fibrin glue injection [20]. These techniques have been reported to be a safer method for the management of the pancreatic remnant and therefore – especially under difficult circumstances – may be useful [17, 18, 19, 20].…”