Surgery for Nonalcoholic Chronic Pancreatitis

Abstract

There are few reports on operations in patients with nonalcoholic pancreatitis. Between 1985 and 1995 we operated on 58 such patients, 38 of whom were male and 20 female with a mean age of 35 years (range 5-72 years). The indications for operation were pain (n = 49), biliary obstruction (n = 12), duodenal obstruction (n = 10), portal hypertension (n = 11), cysts (n = 14), and pancreatic ascites (n = 3). Thirty-four patients with a dilated pancreatic duct underwent pancreaticojejunostomy; cysts were drained internally in eight, and biliary and duodenal obstruction was bypassed. Ten patients also underwent surgery for portal hypertension. Four (7%) patients died during the postoperative period. Of the remaining 54 patients, 48 (89%) were followed up for a median period of 63 months (range 6 months to 10 years). Six died: four of pancreatic cancer, one of cerebrovascular accident, and one of malnutrition. Of the 34 surviving patients operated for pain, 30 (88%) felt better, of whom 24 (71%) had complete relief of pain; 14 (41%) recorded a weight gain. Pancreatic decompression results in immediate and lasting pain relief in most patients with nonalcoholic chronic pancreatitis.

Prospective Study of Pancreatic b‐cell and Exocrine Functionfollowing Duct Decompression in Tropical Calcific Pancreatitis

“…However, it is possible that the 2 patients who avoided follow-up may have done so because of persistence of pain. Our data are in concordance with previous studies in TCP patients, where pain relief was observed in 80%-90% of patients after LPJ [21][22][23]. It implies that elevated ductal pressure plays an important role in the pathogenesis of pain in this entity.…”

Surgery for chronic pancreatitis and different methods of surgeries

“…Relief of symptoms, especially of pain, fatigue, and loss of body weight, accounted for improvement of physical status, working ability and emotional and social functioning. 14 These changes correlated well with the results of the separately assessed pain score and increase of body weight. The visual analog scale, as one feature of the pain score, has been shown to be a reliable and valid tool for measuring painintensity.…”

Pain management in chronic pancreatitis

“…In the paper by Sharma and co-workers [89] 7% of the patients died from disseminated cancer. In all forms of pancreatitis there appears to be a cellular dysfunction, glandular destruction, and presumably increased cell turnover which has been suggested as a potential precursor of cancer in many organs.…”

“…Theoretically, any measure that improves drainage, either by improving flow into the duodenum or by allowing flow into the jejunum or stomach, might be expected to relieve pain. Pancreatic decompression results in immediate and lasting pain relief in a high proportion (80-90%) of patients with non-alcoholic chronic pancreatitis [89], which is higher than most often reported in patients with alcoholic pancreatitis, where pain relief averaged 60% [16]. This result is similar to that reported by Sato et al, who found that over a mean period of 9 years only 56% of patients with alcoholic pancreatitis had good results after surgery, compared to 83% of those who had nonalcoholic pancreatitis [90].…”