OUTCOME OF SURGERY FOR CHRONIC-PANCREATITIS

Background In patients with chronic pancreatitis, surgery is indicated for the management of intractable pain or for the treatment of compli cations. Methods Sixty-three consecutive patients (49 men and 14 women of median age 40 (range 20-72) years) who had undergone surgery over an X-year interval for chronic pancreatitis were studied. The mortalit y and morbidity rates associated with surgery were assessed and qualit y of life was reviewed based on relief of symptoms, analgesic use, emp loyment and long-term sequelae. Results Forty-four patients (70 per ce nt) had alcoholic chronic pancreatitis. In 60 patients the principal i ndication for surgery was intractable pain. Eighteen patients had a du odenum-preserving resection of the pancreatic head (Beger operation); the other surgical procedures were Whipple resection (15), left-sided resection (13), total pancreatectomy (seven), pseudocystjejunostomy (f ive), pancreaticojejunostomy (one) and bypass procedures (four). The m edian inpatient stay was 12 days; 23 patients had postoperative compli cations including one death (2 per cent). There was improved pain cont rol (P < 0.001), a reduction in opiate analgesia use, increase in perc entage weight gain (P < 0.01 at 2 years) and return to employment foll owing surgery. Although there was an increase in diabetes mellitus and need for enzyme supplementation these were easily controlled. Conclus ion Surgery is an effective treatment in carefully selected patients w ith chronic pancreatitis bur must be tailored to the pattern of diseas e in each individual.