Changes in pancreatic resection for chronic pancreatitis over 28 years in a single institution

Background: Because of advances in knowledge over recent years there is rea son to believe that surgical attitudes towards patients with chronic pancre atitis may have changed. Methods: Some 547 patients were treated surgically for chronic pancreatitis from 1971 to June 1998. Anastomoses were performed in 80 per cent (438 pat ients) and resections in 20 per cent (109 patients). Indications and type o f operation were analysed, as were mortality and morbidity rates and long-t erm follow-up results, in patients undergoing resection both over the perio d as a whole and after dividing the series into two subperiods of 14 years. Results: In the second 14-year period, there was a significant reduction in the percentage of resections compared with anastomoses (28 per cent (69 of 244 patients) versus 13 per cent (40 of 303); P < 0.0001), and a significa nt change in the type of resection with a substantial increase in resection s of the head compared with those of the body and tail. Statistically signi ficant reductions occurred in operating times, number of units of blood tra nsfused (mean(s.d.) 4.7(3.6) versus 1.2(1.6) units; P = 0.0001) and mean ho spital stay (18 versus 14 days for pylorus-preserving and 12 versus 8 days for left pancreatectomy with splenectomy; P < 0.01); mortality and morbidit y rates also tended to decrease, but not significantly. Conclusion: A different pattern has emerged over the years as regards both the type and number of resections performed.