Changing trends in operations for chronic pancreatitis: a 22-year experience

Objective: To report the evolution of methods of surgical treatment of chro nic pancreatitis. Design: Retrospective analysis. Setting: Private clinic, USA. Subjects: 448 consecutive patients who were operated on for chronic pancrea titis. Interventions: Resection (n = 286) or drainage of the duct (n = 162). Main outcome measure: Changes over the 22-year period. Results: There was a change towards resection after 1985 (195/238, 59%, fro m 1976-90 compared with 91/120, 76%, from 1991-97), partly because of suspi cions of malignancy. In recent years (1991-97) pylorus -preserving pancreat icoduodenectomy has come to be preferred over classic resection including a ntrectomy (22/36, 61%, compared with 11/69, 16%). Eight duodenum-preserving resections have been done since 1994. Conclusions: More resections, particularly proximal pancreatectomies, are d one nowadays. Lateral pancreaticojejunostomy has become the preferred drain age procedure, and pylorus-preserving pancreaticoduodenectomy is favoured o ver classic pancreatwicoduodenectomy.