HETEROTOPIC AUTOTRANSPLANTATION OF A PANCREAS SEGMENT WITH ENTERIC DRAINAGE AFTER TOTAL OR SUBTOTAL PANCREATECTOMY FOR CHRONIC-PANCREATITIS

Four patients with chronic alcoholic pancreatitis and one patient with idiopathic chronic pancreatitis, who had total or subtotal distal pan createctomies for persistent pain, underwent simultaneous autotranspla ntation of a pancreas segment to preserve the pancreatic function. The segment was autotransplanted heterotopically to the iliac fossa with anastomosis of the splenic vessels to the iliac vessels to prevent rei nnervation, and the pancreatic duct was anastomosed to the intestine t o preserve exocrine function. Postoperatively, the patency of the graf t vessels was confirmed by angiography in every patient. Complete pain relief has been obtained in all patients with a followup duration of 4-89 mo. Except for one patient who had been treated preoperatively wi th insulin injections for diabetes, the patients remained normoglycemi c without exogenous insulin administration and demonstrated satisfacto ry insulin secretion during a 75-g oral glucose tolerance test. An exo crine pancreatic diagnostant test using p-aminobenzoic acid yielded ne arly similar levels to the preoperative value for all patients. Hetero topic autotransplantation of the pancreas segment appears to be effect ive for preserving pancreatic function, as well as providing permanent pain relief for patients with chronic pancreatitis who require extens ive resection of the pancreas.