Surgery for chronic pancreatitis: a review of 12 years experience

The surgical management of chronic pancreatitis remains controversial. We have practised a selective approach to surgery using symptoms and endoscopic retrograde cholangiopancreatography (ERCP) as the indications for operation and the procedure performed. A total of 76 patients who underwent surgery for chronic pancreatitis over a 12 year period were reviewed. Of the patients, 24 (32%) had a Whipple's resection (WR), 41 (54%) distal pancreatectomy (DP) with drainage, and 11 (14%) had other procedures. Eleven patients had died. Hospital records were reviewed and of the 65 patients alive at follow-up, 51 (79%) were interviewed. Twenty-three patients (74%) who underwent DP reported either excellent or good general health compared with 7 (44%) who had WR (P = 0.04). However, there was no difference in general health between operative groups using visual analogue scales. There was no difference in pain at follow-up between DP and WR. Of patients interviewed, 88% felt that their pain was better than before operation and 25 (49%) had no pain at all. Diabetes developed more frequently after DP (P = 0.005) than after WR. Good results can be achieved by pancreatic resection when careful selection is exercised.