Pancreatoduodenectomy in the treatment of chronic pancreatitis

The value of surgical resection for patients with chronic pancreatitis has been debated on account of persistent symptoms and the morbidity of the operative procedure, both immediate and delayed. This paper explores the consequence of pancreatoduodenectomy in 175 patients with chronic pancreatitis who were operated on between 1976 and 1997. All patients were carefully selected after varying periods of conservative management. The operation was a classical Kausch-Whipple resection in 98 patients and a pylorus-preserving procedure in 67. There were four postoperative deaths (days 7, 10, 35, and 70), and only two reoperations were performed. The median number of postoperative events was one, with delayed gastric emptying being the most common (31 patients). The median length of in-hospital stay was 20 days (range: 8-215 days), but no patient was discharged until medical and social disabilities were resolved. There were seven late deaths, most of them linked to cigarette smoking and alcohol consumption; 75% of patients had a good clinical outcome, but 18 patients required further pancreatic surgery at a mean of 12 months, either a pancreatojejunostomy or a completion pancreatectomy. Diabetes occurred in 40% of patients by 5 years, and most, at some stage of their postoperative period, required pancreatic enzyme supplementation. It is suggested that resection of the pancreas provides a reasonable life-style in 75% of patients, but the outcome depends in large part on the predisposing disease.