Choice of Appropriate Procedure for Surgical Treatment of Chronic Pancreatitis

Yutaka Atomi, Masanori Sugiyama, Akira Kuroda, Yasuhiko Morioka

First Department of Surgery, University of Tokyo

Ninety-eight patients with chronic pancreatitis underwent surgery at our institute between 1970 and 1990. The mean age was 46.7 years and the male to female ratio was 79:19. The etiology of the pancreatitis was alcohol in 59 cases, gallstones in 12, and idiopathic or other causes in 27. All of the alcoholic patients were male and 6 years younger, on average, than those with chronic pancreatitis due to gallstone. The reasons for surgery were intractable pain in 85% of the cases, cyst formation in 40%, and jaundice in 16% respectively. Others included gallstones, suspicion of cancer, and fistula formation. The surgical procedure was determined by considering the configuration of the main pancreatic duct, localization of the disease, presence or absence of cysts, and biliary tract findings, collectively. Thirty-two patients with irregular dilatation of the main pancreatic duct were treated with pancreaticojejunostomy, and 8 cases with cysts were treated with cystogastrostomy or cystojejunostomy as the final operation. In patients with suspicion of cancer or with a cyst in the tail and/or body, pancreatic resection was the treatment of choice. Others, especially those without dilatation of the pancreatic duct, were treated mainly with neurectomy. One patient died of hemorrhagic complications after pancreaticoduodenectomy. More than 80% of the patients were almost free of pain at follow up. Four patients died of complications of diabetes mellitus. Control of glucose intolerance is one of the most important postoperative problems facing patients with chronic pancreatitis.

Key words
chronic pancreatitis, pancreaticojejunostomy, pancreatic stone, bile duct stricture, diabetes mellitus

Reprint requests
Yutaka Atomi First Department of Surgery, University of Tokyo
7-3-1 Hongo, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
July 3, 1991

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