Outcome of surgical treatment of chronic pancreatitis associated with sphincter of Oddi dysfunction

The clinical management of patients with chronic pancreatitis (CP) associat ed with sphincter of Oddi dysfunction (SOD) presents many challenges. The a im of this study was to evaluate patient outcome after surgical management of CP associated with SOD intractable to medical management. The records of patients with CP and SOD who underwent surgical treatment between 1994 and 1998 were retrospectively reviewed and analyzed. Manometry of biliary and pancreatic ducts was performed. Basal pressures were considered abnormal if greater than or equal to 40 mm Hg for at least 30 seconds. Endoscopic retr ograde cholangiopancreatography, endoscopic ultrasound, and clinical criter ia were utilized in the diagnosis of CP. Quality-of-life issues were assess ed. Twenty-nine patients were identified (21 women and eight men) with a me an age of 43.3 years (range 24-54). Mean basal biliary and pancreatic sphin cter pressures were 155.1 and 90.4 mm Hg respectively. Chronic pancreatitis was graded as mild in nine patients, moderate in six, severe in two, and n ormal or equivocal in 12 patients according to the Cambridge classification . A Whipple procedure was performed in 17 (59%) patients, lateral pancreati cojejunostomy in nine (31%), and distal resections or a combination of proc edures in three (10%). The morbidity and mortality rates were 21 and 0 per cent respectively. Mean follow-up was 30 months (range 3-48). Pain relief r anging from fair to excellent was seen in 83 per cent of patients with pain scores decreasing from an average of 9 (scale 1-10) before surgery to 3 po stoperatively. Seventy per cent maintained their weight, 45 per cent contin ued to require pancreatic enzyme supplementation, and there were no changes in the status of diabetes. Rehospitalizations for recurrent pancreatitis o r persistent pain were necessary in 24 per cent of patients. Surgical manag ement of patients with CP and SOD who fail medical management is safe and e ffective in most patients. Operative morbidity and mortality are low, and t he majority of patients have improvement in pain, although some require reh ospitalization for recurrent pancreatitis and chronic pain.