LOCAL RESECTION OF THE HEAD OF THE PANCREAS COMBINED WITH LONGITUDINAL PANCREATICOJEJUNOSTOMY IN THE MANAGEMENT OF PATIENTS WITH CHRONIC-PANCREATITIS

Operation Local resection of the head of the pancreas combined with lo ngitudinal pancreaticojejunostomy of the body and tail of the pancreas (LR-LPJ) was designed to improve decompression of the head of the pan creas, which often was not drained well by standard longitudinal pancr eaticojejunostomy. This was achieved by excising the head of the pancr eas overlying the ducts of Wirsung and Santorini, and duct to the unci nate, along with their tributary ducts. Patient Material The operation has been performed on 50 patients. There were five late deaths among the 50 patients; two at 6 months, and one each at 24, 26, and 91 month s. Eighty percent of the patients were alcoholics, 50% had pseudocysts , and 80% had calcification. Assessment Pain was assessed on a scale o f 1 to 10, with 10 being most severe. Narcotic intake was considered m inimal-Vicodin equivalent (hydrocodone bitartate, 5 mg, acetaminophen, 500 mg; Vicodin, Knell Pharmaceuticals, Whippany, NJ) once or twice/m onth; moderate-Vicodin weekly, daily; and major-meperidine hydrochlori de (Demerol, Winthrop Pharmaceuticals, New York, NY) weekly or daily.R esults Pain relief in 47 patients was excellent (74.5%), improved in 1 2.75%, and unimproved in 12.75%. Endocrine status in 45 patients was a s follows: 69% were not diabetic, and 20% were diabetic preoperatively and postoperatively. Postoperatively, 11% had progression of their di abetes. Exocrine function was not worsened and may have been improved in same patients. Sixty-four percent of 39 patients gained an average of 15.3 pounds. Fifty-nine percent of patients were not working preope ratively or postoperatively. Conclusions The LR-LPJ provides good pain relief with a modest increase in endocrine and exocrine insufficiency and a significant increase in weight. Even when relieved of pain, pat ients seldom return to the work force.