SURGICAL INTERVENTION FOR REGIONAL COMPLICATIONS OF CHRONIC-PANCREATITIS

In a five year review of 648 patients with chronic pancreatitis, 446 ( 68.8%) were documented with regional complications consisting of bilia ry, duodenal or colonic obstruction, pseudocysts, haemorrhage, pancrea tic ascites and gastric varices. Although the majority could be treate d conservatively, surgical intervention was needed in 129 patients (28 .9%). The commonest operations were choledocho-duodenostomy for distal bile duct obstruction, gastro-enterostomy for duodenal obstruction, l ocal resection for colon obstruction, cyst-gastrostomy for pseudocysts , duct-enteric anastomosis for pancreatic ascites and splenectomy for gastric varices. Operative mortality was 8.5% and morbidity 27.9%. Dur ing 1-5 year follow-up, re-admission for pancreatitis was needed in 24 %. No secondary biliary cirrhosis was encountered in long standing bil e duct obstruction, but fibrosis was present in 73% of liver biopsies. Cholangitis occurred in 14%. Angiographic embolisation was useful in the control of massive bleeding from peri-pancreatic visceral arteries . Although relief of pain in chronic pancreatitis has generally been d isappointing, regional complications, occurring in the majority of pat ients, can be corrected satisfactorily by surgical intervention.