DRAINAGE VERSUS RESECTION IN CHRONIC-PANC REATITIS PREDOMINANTLY INVOLVING THE HEAD OF THE PANCREAS - A RANDOMIZED STUDY

Drainage and resection are the principles of surgery in chronic pancre atitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Beger and Frey combine both to different degrees. In a prospective randomized trial both procedures were compa red: 74 patients were randomly allocated to either Beger's (n = 38) or Frey's (n = 36) group. In addition to routine pancreatic diagnostic w ork-up a multidimensional psychometric quality-of-life questionnaire a nd a pain score were used. Assessment of endocrine and exocrine functi on included oral glucose tolerance test, serum concentrations of insul in, C-peptide, and HbA(1c), as well as fecal chymotrypsin and pancreol auryl test. The mean interval between symptoms and surgery was 5.1 yea rs (1-12 years). The median follow-up was 30 months. There was no mort ality. Overall morbidity was 27 % (32 % Beger, 22 % Frey). Complicatio ns from adjacent organs were definitively resolved in 91 % (92 % Beger , 91 % Frey). A decrease in pain score of 95 % and 93 % after Beger's and Frey's procedure, respectively, and an increase of 67 % in the ove rall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between the two groups. Both techniq ues of duodenum-preserving resection of the head of the pancreas are e qually safe and effective with regard to pain relief, improvement of q uality of life, and control of complications affecting adjacent organs . Neither procedure leads to further deterioration of endocrine and ex ocrine pancreatic function.