Surgical decompression of ductal obstruction in patients with chronic pancreatitis

Background. Recurrent acute pancreatitis often leads to chronic obstructive ductal disease requiring operative decompression. Methods. From 1983 through 1998 124 patients with ductal obstruction underw ent lateral pancreaticojejunostomy (78 patients), distal pancreatectomy wit h end-to-side pancreaticojejunostomy (27 patients), distal pancreatectomy w ith placement of a pancreas with a filleted duct within a jejunal limb (15 patients), or pancreaticoduodenectomy (4 patients). Preoperative symptoms i ncluded abdominal and back pain (99%), nausea with vomiting (99%), and diar rhea with weight loss (11%). Associated conditions included hypertension (2 0%) and diabetes mellitus (12%). Endoscopy in 106 patients demonstrated dis tal stricture (37%), proximal stricture (36%), pseudocyst (30%), chain of l akes (15%), calcification and debris (19%), and bile duct stricture (8%). Results. Two patients died, one of an unrecognized esophageal perforation d uring intubation and the of her of leakage of a 1-layer pancreaticojejunost omy. Thirty-six patients developed 53 complications including intra-abdomin al abscess (7 patients) and bleeding requiring reoperation in I patient. Pa in relief was complete in 61 patients, substantial in 39 patients, moderate in 11 patients, minimal in 8 patients, and nonexistent in 3 patients with multiple stones and narrow duct. Ten patients died with 6 deaths as a resul t of pancreatic cancer Two other patients may have died of pancreatic cance r. Conclusions. Lateral pancreaticojejunostomy is the procedure of choice in m ost patients. Recurrent pancreatitis usually follows alcoholic binges. Long -term follow-up must assess for pancreatic cancer.