Management of recurrent pain following previous surgery for chronic pancreatitis

The management of any patient with recurrent pain following surgery for chronic pancreatitis is far from an easy problem. Even more careful assessment than that preceding the decision for the first operation will be necessary. In-hospital patient assessment is strongly recommended to ascertain the degree of the problem of pain in as objective a manner as possible. The effects of alcohol withdrawal and different analgesic treatments have to be carefully assessed while obtaining essential information on the size and shape of the pancreatic duct as well as the general pancreatic morphology. Relatively simple procedures such as the removal of stones or the enlargement of a strictured anastomosis may be all that is required to ensure freedom from pain; however, there is a tendency for patients who have no obvious new pathology or simple failure of the first operation to move to more extensive resectional procedures. This, ultimately will lead to total pancreatectomy being recommended and long-term follow-up of such patients is under critical scrutiny. Unless the highest caliber of support services can be mustered for these patients subject to total pancreatectomy, the morbidity and mortality in the longer term can reach prohibitive levels. A plea is made for objective reassessment of the place of celiac ganglionectomy in the management of these difficult problems.