<Review>Surgical treatment of chronic pancreatitis : clinical survey of 27 patients

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Between the years 1978 and 1985,a total of 27 patients with chronic pancreatitis underwent surgical procedures. The ages ranged from 15 to 85 years, with an average of 53.1 and with male-to-female ratio of 2.9 : 1. The suspected causes were abuse of alcohol in 13 males (48%), idiopathic onset in 9 patients (33%) and gallstones in 4 (15%). Their chief complaints were abdominal pain in 24 patients (89%), back pain in 13 (48%), weight loss in 10 (37%) and jaundice in 5 (19%). Among the preoperative assessments utilizing imaging medalities, 96% of the cases examined by ERCP, 80% of the cases by US and 73% of the cases by CT showed abnormal results suggesting the diseased pancreas, respectively. The interval between the onset of suspicious symptoms and the initial surgery ranged from 23 days to 24 years with a mean of 50.2 months. To relieve the pain, 19 patients underwent a total of 20 operations, seven patients were explored on suspicion of pancreatic neoplasms, and another underwent urgent laparotomy for a ruptured pseudocyst. Diffuse involvement of the pancreas with dilated main pancreatic duct was noted in 8 patients, who underwent longitudinal pancreaticojejunostomy ; 8 patients without dilated duct underwent 5 of resection (including one of reresection) and 4 of biliary tract surgery. So-called localized chronic pancreatitis was noted in 10 patients, of whom resection of the diseased portion was performed in 6. Among the complications, pancreatic calculi were present in 13 patients (48%), pseudocyst in 12 (44%) and bile duct stricture in 8 (30%). Almost all of them were treated with adequate surgery. Operative mortality was 3.6% and morbidity 21.4%. Two patients died of carcinomas and two patients were lost to follow-up. Twenty patients alive for more than 6 months postoperatively were surveyed by mail. Although relief from pain was well achieved in 70% of the 20 patients, the results for weight gain and recovery of the ability to work are unsatisfactory. Each operation for chronic pancreatitis should be tailored to each patient in consideration of cause, degree, location, complication of inflammation, and pancreatic duct status.
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<Review>Surgical treatment of chronic pancreatitis : clinical survey of 27 patients

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