Sphincterotomy or sphincteroplasty in the treatment of pathologically mild chronic pancreatitis

We reviewed 67 patients with a mild to moderate degree of chronic pancreatitis, 33 of whom had sphincterotomy and 34 of whom had sphincteroplasty of the sphincter of Oddi and the sphincter of the pancreatic duct. The cause of the pancreatitis was idiopathic in 35 and probably alcoholic in 32. Initial relief of symptoms at 6 months was acceptable in both groups (mean, 64 percent), but thereafter decreased at 2 years and 5 years postoperatively to significant relief in only 48 and 44 percent of patients, respectively. The more complex sphincteroplasty appears to offer no advantage over the simpler sphincterotomy in the management of patients with pain of pancreatitis. In the patients who were alcoholics, avoidance of alcohol seems to be a much more important determinant of the outcome of the operation than the operation itself.