Santoriniplasty in the management of symptomatic pancreas divisum

Objective: To assess the long-term results of sphincteroplasty of the minor papilla in a series of patients with symptomatic pancreas divisum. Design: Retrospective study. Setting: University hospital, UK. Subjects: 6 consecutive patients with rec urrent acute pancreatitis thought to be caused by pancreas divisum. Interventions: Surgical enlargement of the minor papilla of Santorini (Sant oriniplasty). Main outcome measures: The effectiveness of the procedure in preventing fur ther episodes of acute pancreatitis and controlling chronic intermittent pa ncreatic pain, outside documented attacks of pancreatitis. Results: Median follow up was 4 years (range: 1-6). The procedure was effec tive in preventing further episodes of recurrent acute pancreatitis (in all patients) but not uniformly good in controlling chronic pancreatic pain (g ood: 2/6, moderate: 1/6, poor: 3/6). Conclusion: The prevention of further attacks of acute pancreatitis by Sant oriniplasty indicates that a short term favourable clinical outcome may be achieved by improving drainage of the pancreatic duct through the stenosed minor papilla. Poor pain control may indicate early parenchymal changes or that unsuitable patients had been selected for surgical intervention. At pr esent, there are no objective tests of pancreatic function that can predict which patients are most likely to benefit from Santoriniplasty. Prospectiv e studies with more patients followed up for longer periods of time are nee ded before the role of the surgical drainage in symptomatic pancreas divisu m can be clearly defined.