LONGITUDINAL V-SHAPED EXCISION OF THE VENTRAL PANCREAS FOR SMALL DUCTDISEASE IN SEVERE CHRONIC-PANCREATITIS - PROSPECTIVE EVALUATION OF A NEW SURGICAL-PROCEDURE

Objective The technique of longitudinal V-shaped excision of the ventr al pancreas for small duct chronic pancreatitis is presented and its e fficacy in terms of pain relief and improvement of quality of life is evaluated. Summary Background Data Small duct chronic pancreatitis has been regarded as a classical indication for more or less extensive re section, in which the therapeutic success of pain relief is offset by the considerable risk of significant perioperative mortality and morbi dity and the burden of substantial loss of pancreatic function. Method s Thirteen patients with severe pain who were diagnosed with small duc t pancreatitis (defined as maximal Wirsungian ductal diameter of 2 mm) underwent longitudinal V-shaped excision of the ventral pancreas. In addition to routine pancreatic workup, a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Assessment of exocrine and endocrine function included fecal chymotrypsin and the pancreolauryl test as well as oral glucose tolerance, serum concentra tions of insulin, C-peptide, and hemoglobin A(1c). The interval betwee n symptoms and surgery ranged from 12 months to 10 years (mean, 5.4 ye ars). Median follow-up was 30 months (range, 12-48 months). Results Th ere were no deaths. Overall morbidity was 15.4%. In 92% of patients, c omplete relief of symptoms was obtained. Median pain score decreased b y 95%. Physical status, working ability, and emotional and social func tioning scores improved by 40%, 50%, 67%,, and 75%, respectively. Glob al quality-of-life index increased by 67%. Occupational rehabilitation was achieved in 69% of patients. Exocrine and endocrine pancreatic fu nction was well preserved. Conclusions In small duct chronic pancreati tis, longitudinal V-shaped excision of the ventral pancreas is a safe and effective alternative to resection procedures. The new technique p rovides pain relief and improvement of quality of life, thus offering the benefit of a resection procedure without its burden.