[A new surgical method for chronic pancreatitis: Vankemmel's wirsungo-sphincteroclasis (50 cases)]

Since 1986, Vankemmel M. has been advocating, in case of severe chronic pancreatitis with dilatation, even slight, of the pancreatic duct without associated cavity formation, to carry out wirsungosphincteroclasis (W-SC): 50 cases. This original technique includes a short cephalic wirsungotomy followed by the removal of canal obstruction by transampullary wirsungoduodenal caliber restoration, then a temporary wirsungonasal drainage. This procedure has been associated to a biliodigestive anastomosis in 27 cases, including 25 cases in which a gallbladder loop was used.

Only one patient (2%) who had already been treated with caudal splenopancreatectomy with pancreaticojejunal anastomosis and presented with portal thrombosis and compression of the common bile duct, died of mesentericointestinal infarction during the postoperative period. During the first month, no pancreatic fistula was noted but 3 patients were operated again: one at D3 to reposition the torn-off wirsungonasal drain, one for angiocholitis requiring a biliodigestive anastomosis, and the third one for acute intestinal obstruction. Later on, only 4 patients (8%) were operated on successfully (3rd, 16th, 20th, 33rd month) to complete the removal of canal obstruction.