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Surgical therapy and follow-up of pancreatitis in children
C Petersen1, A Goetz, D Bürger
1Department of Pediatric Surgery, Medical School Hannover, Germany.
Insights
Surgical intervention for acute pancreatitis in children is reserved for complicated cases. Early surgery for chronic relapsing pancreatitis in children yields good results, preserving pancreatic function.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pancreatology
Background:
- Pediatric pancreatitis etiology and treatment differ significantly from adults.
- Blunt abdominal trauma is the most common cause of acute pancreatitis in children, often requiring emergency laparotomy and drainage.
- Chronic relapsing pancreatitis, especially hereditary forms, is rare in children and necessitates distinct therapeutic strategies.
Purpose of the Study:
- To evaluate the surgical treatment outcomes for acute and chronic relapsing pancreatitis in children.
- To assess the efficacy of early operative intervention for chronic pancreatitis in pediatric patients.
Main Methods:
- A retrospective analysis of 16 pediatric patients who underwent surgery for pancreatitis between 1976 and 1988.
- Inclusion of patient history, postoperative course, and final examination data.
Main Results:
- Eight children with acute pancreatitis showed good outcomes after surgery, with an average follow-up of 7.5 years.
- Children with chronic relapsing pancreatitis (average age 9 years) treated early (2.7 years post-symptom onset) experienced only mild relapses during an average 5.4-year follow-up.
Conclusions:
- Operative treatment with internal drainage for acute pancreatitis in children is indicated only for complications when conservative measures fail.
- Early surgical intervention in pediatric chronic relapsing pancreatitis is justified by preserved exocrine and endocrine pancreatic function.
- Timely surgical management in pediatric pancreatitis with characteristic pancreatic duct changes is crucial for symptom resolution and function preservation.
Background:
Acute and chronic pancreatitis in children differ from that in adults both from the etiology and the therapeutic approach. Within the frame of a blunt abdominal trauma-the most frequent cause in children-acute pancreatitis is often detected by emergency laparotomy and external drainage is recommended. Chronic relapsing pancreatitis, and particularly its hereditary form, is very rare in children and requires a different therapeutic concept. The results of surgical therapy for both forms of pancreatitis in childhood were evaluated in the present study.
Methods:
Sixteen patients with acute and chronic relapsing pancreatitis were operated on in our facility between 1976 and 1988. Their history and postoperative course were analyzed in a retrospective study, including a final examination at the end of the follow-up period.
Results:
Eight children with acute pancreatitis were operated on at an average age of 6 years and were followed up for an average of 7.5 years, with good results. The remaining children, aged between 3 and 14 years (average age of 9 years), were operated on for chronic relapsing pancreatitis. Our experience with early operative treatment, on average 2.7 years after onset of symptoms, is presented. Only three patients experienced a mild relapse during the follow-up period of 2-13 years (average of 5.4 years).
Conclusions:
For acute pancreatitis in childhood, operative treatment by inner drainage is necessary and effective only in case of complications, should conservative treatment fail. In children with chronic relapsing pancreatitis, the good exocrine and the normal endocrine function of the pancreas in these patients justified the early operation. Timely treatment is recommended in cases with typical changes of the pancreatic duct so as to shorten the relapsing clinical problems of the children and to maintain the function of the pancreas.