Operative management of chronic pancreatitis in children

Hypothesis: Chronic pancreatitis in childhood is a rare but potentially deb ilitating disorder, and failure of conservative therapy with chronic pain m edication use is common. We hypothesize that aggressive surgical therapy ma y hold promise for long-term remission. Design: Retrospective analysis of data collected prospectively for 12 years . Setting: Tertiary care children's hospital. Patients: Eighteen children (aged 3-13 years, 11 girls) underwent surgical treatment of chronic pancreatitis after 1 to 6 years of various medical the rapies (parenteral nutrition, somatostatin, or pain medication). These pati ents required a mean +/- SD 6 +/- 0 hospitalizations before operation. Panc reatitis was familial in 9 patients, idiopathic in 5, and secondary to trau ma and medication use in 2 each, Preoperative endoscopic retrograde cholang iopancreatography showed pancreatic duct dilatation in 7, strictures in 5, ductal stones in 4, and normal findings in 2. The operative therapy consist ed of longitudinal pancreaticojejunostomy in 2 children (both children fail ed pancreaticojejunostomy but improved after undergoing pancreatectomy) and distal pancreatectomy with Roux-en-Y pancreaticojejunostomy in 14 children . Outcome Measures: Survival, need for rehospitalization or reoperation, and chronic pain medication requirements. Results: All patients survived. Follow-up ranged from 1 to 15 years. Thirte en (72%) of 18 patients have required no further hospitalizations or medica tions. Two patients required a second operation to convert their longitudin al pancreaticojejunostomy to distal pancreatectomy, and 3 patients have req uired 2 to 5 additional hospitalizations for recurrent pancreatitis. Endosc opic retrograde cholangiopancreatography on 5 patients 2 to 4 years postope ratively showed patent distal pancreaticojejunostomy. Conclustons: This series suggests that distal pancreatectomy and pancreatic ojejunostomy are effective treatments for this difficult group of patients, while longitudinal pancreaticojejunostomy was ineffective. Long-term relie f of pain and reduced need for rehospitalization are the usual results afte r this procedure.