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Changing trends in operations for chronic pancreatitis: a 22-year experience
1Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Objective:
To report the evolution of methods of surgical treatment of chronic pancreatitis.
Design:
Retrospective analysis.
Setting:
Private clinic, USA.
Subjects:
448 consecutive patients who were operated on for chronic pancreatitis.
Interventions:
Resection (n = 286) or drainage of the duct (n = 162).
Main Outcome Measure:
Changes over the 22-year period.
Results:
There was a change towards resection after 1985 (195/238, 59%, from 1976-90 compared with 91/120, 76%, from 1991-97), partly because of suspicions of malignancy. In recent years (1991-97) pylorus-preserving pancreaticoduodenectomy has come to be preferred over classic resection including antrectomy (22/36, 61%, compared with 11/69, 16%). Eight duodenum-preserving resections have been done since 1994.
Conclusions:
More resections, particularly proximal pancreatectomies, are done nowadays. Lateral pancreaticojejunostomy has become the preferred drainage procedure, and pylorus-preserving pancreaticoduodenectomy is favoured over classic pancreaticoduodenectomy.