SURGICAL-MANAGEMENT OF CHRONIC PAIN FROM CHRONIC-PANCREATITIS

Chronic pain from chronic pancreatitis remains a difficult clinical pr oblem. We present the results of surgical attempts to control this pai n. For the past 3 years, all patients with chronic pancreatitis and pa in requiring high-dose narcotics or hospitalization for pain control w ere evaluated by the following algorithm. Any anatomic pathology causi ng ductal dilatation was surgically addressed first (Puestow's procedu re, pseudocyst drainage, or sphincteroplasty). If there was no evidenc e of ductal dilatation, or if pain recurred postoperatively, denervati on procedures were performed (splenopancreatic flap, thorascopic sympa thectomy, or resection). Pain recurrence was defined as the need for f urther hospitalization or reoperation. Data were analyzed by compariso n of two proportions. Follow-up averaged 26 months. Thirty-seven patie nts underwent 44 operations solely in an attempt to control pain; 62 p er cent were male, and 70 per cent had chronic alcoholic pancreatitis. Our results show that surgical management provides relief in 68 per c ent of patients, and no one procedure is clearly superior to others.