DUODENUM-PRESERVING TECHNIQUES OF RESECTI ON OF THE HEAD OF THE PANCREAS IN THE TREATMENT OF CHRONIC-PANCREATITIS

Aim of the Study: To evaluate the efficacy of duodenun-preserving rese ctions of the head of the pancreas in the treatment of chronic pancrea titis this study was devised. So far studies on the natural course and the different therapeutic approaches have primarily focused on pain m easurement in rough categories and hard data as mortality and morbidit y. In this study the improvement of the quality of life was assessed t o determine the therapeutic success of both procedures. Patients and M ethods: In a prospective randomized study 24 patients underwent either Beger's (n=11) or Prey's procedure (n=13) so far. 15 patients suffere d from distal common bile duct stenosis, 2 from segmental duodenal ste nosis, 4 from segmental portal hypertension, and one from pancreato-pl eural fistula. The quality of life questionnaire of the European Organ ization for Research and Treatment of Cancer was assessed before surge ry and during follow-up. The multidimensional questionnaire incorporat es functional scales (physical, cognitive, emotional, and social), sym ptom scales (fatigue, pain, dyspnea, loss of appetite, sleep disturban ce, obstipation, diarrhea, nausea, and vomiting), and a global quality of life scale. Follow-up was 12 months in all patients. Results: Ther e was no postoperative mortality in neither group, Postoperative morbi dity was 17% (n=2 in either group). This included one transitory commo n bile duct stenosis, one bronchopneumonia, and two postoperative blee dings which were treated conservatively. The pain index was reduced by 94% in the Beger- and 90% in the Frey group. The physical status, wor king ability, emotional and social functioning, and global quality of life score had significantly improved by 46%, 50%, 69%, 60%, and 67% i n the Beger group and by 38%, 50%, 64%, 80%, and 67% in the Frey group . Conclusion: The duodenum-preserving resections of the head of the pa ncreas according to Beger and Frey are equivalently safe and effective . Both techniques result in a significant improvement of the patients' quality of life.