Surgical Treatment of Chronic Pancreatitis: Indications and Results in 246 Consecutive Patients

Abstract

From 1972 to 1986, 246 patients, with a large majority of alcoholics, were operated on for chronic pancreatitis. Mean age was 44.2 ± 23.4 years and the male/female sex ratio was 217/29. In 223, 22 and 1 patients, 1, 2 or 3 laparotomies were performed, respectively. In 12 patients laparotomy was only explorative. In all others, at each laparotomy, 1 surgical procedure was performed in 207 patients, 2 procedures in 42, 3 procedures in 8 and 4 procedures in 1. These various procedures were as follows: external drainage: 17; biliary, gastric, pancreatic, cystic internal diversions: 142; distal pancreatectomy: 51; pancreaticoduodenectomy: 47; total pancreatectomy: 1. Abdominal pain was the most frequent symptom (60%). Morphological features other than pancreatic abnormalities were frequent: biliary and duodenal obstructions account for 40 and 23.5% of the surgical indications, respectively. The choice among these numerous surgical options are presented in detail and discussed. Overall operative mortality was 7.7% (patients), 7% (laparotomy), 9% in the resection group and 5.8% in the other group. Our best long-term results were observed after the Whipple procedure with a 15-year survival rate of 74.5%.

Surgical management of chronic pancreatitis on the continent of Europe

“…Pancreaticoduodenectomy has the advantage of treating or preventing almost all of the complications of the disease, thus explaining the low rate of reoperation. Current trends in Europe include the performance of fewer resections and more pancreaticojejunostomies than 10 years ago, In a recent review of 242 cases of chronic pancreatitis treated surgically, Launois and co-workers [53] noticed that the rate of resection had fallen from 46% to 28% since 1980. Nevertheless, pancreaticoduodenectomy retains an important role in cases with biliary or duodenal involvement.…”