[Chronic pancreatitis--drainage or resection?]

In certain cases of chronic pancreatitis, the severity of the disease can lead to surgery. In the indication for operation 4 factors are determining: development of complications, severe intractable pain, cachexia of pancreatic origin, and the diminishing cases of suspicion of carcinoma. The surgical strategy depends mostly on the enlargement of the Wirsungian duct and on the topography of the lesions. Has the Wirsungian duct reacted at least 1 cm in diameter on 6-7 cm length, a latero-lateral isoperistaltic wirsungo-jejunostomie with Roux-en-Y loop seems to be a worthwhile procedure. Are the lesions located predominatly in the head of the pancreas with a narrowed Wirsungian duct, a subtotal duodenopancreatectomy is indicated. If the body and tail of the gland are mostly involved, a left pancreatectomy will be performed, combined with one of the different possibilities of a retrograde drainage of the remaining right pancreas. Follows a critical analysis of the 197 cases operated by the authors. After discussion of mortality and morbidity, late results are studied, patients being divided into 2 groups according to a follow-up of 5 years or less. 56% of the patients treated by subtotal duodenopancreatectomy demonstrated good results after 5 years. But only 43 % of patients with a wirsungo-jejunostomy and 38% of patients with left pancreatectomy belonged to this group. Finally, arguments in favour of a drainage procedure or resection are specified.