Surgical management of chronic pain from chronic pancreatitis

Chronic pain from chronic pancreatitis remains a difficult clinical problem. We present the results of surgical attempts to control this pain. For the past 3 years, all patients with chronic pancreatitis and pain requiring high-dose narcotics or hospitalization for pain control were evaluated by the following algorithm. Any anatomic pathology causing ductal dilatation was surgically addressed first (Puestow's procedure, pseudocyst drainage, or sphincteroplasty). If there was no evidence of ductal dilatation, or if pain recurred postoperatively, denervation procedures were performed (splenopancreatic flap, thorascopic sympathectomy, or resection). Pain recurrence was defined as the need for further hospitalization or reoperation. Data were analyzed by comparison of two proportions. Follow-up averaged 26 months. Thirty-seven patients underwent 44 operations solely in an attempt to control pain; 62 per cent were male, and 70 per cent had chronic alcoholic pancreatitis. Our results show that surgical management provides relief in 68 per cent of patients, and no one procedure is clearly superior to others.