Choice of Operative Procedures for Chronic Pancreatitis and Results of Long Term Follow-up

Shuji Isaji, Shigeki Miyahara, Kazunori Okamura, Yoshifumi Ogura, Takashi Noguchi, Yoshifumi Kawarada, Ryuji Mizumoto

First Department of Surgery, Mie University School of Medicine

Choice of operative procedures for chronic pancreatitis and results of long term follow-up were studied in the 52 patients who underwent pancreatic duct drainage or pancreatectomy among 60 surgical patients. In the group of 28 patients with a dilated main pancreatic duct, longitudinal pancreaticojejunostomy was performed in 22 with multiple duct stenosis. Sphincteroplasty with pancreatic duct plasty was performed in 4 patients who had pancreatic duct stenosis near the papilla of Vater. Of 2 patients who had ductal stenosis in the pancreatic head, one had pancreaticoduodenectomy and the other had double pancreaticojejunostomies with local resection of the pancreatic head. In the group of 24 patients without a dilated main pancreatic duct, total pancreatectomy was performed in 1 patient with diffuse pancreatic parenchymal lesions. Of 3 patients who had pancreatic lesions located in the pancreatic head, pancreaticoduodenectomy was selected for 2 and cystojejunostomy for 1. Of 20 patients who had pancreatic lesions located in the pancreatic tail, distal pancreatectomy was selected for 18 and cystojejunostomy for 2. In the late postoperative period of more than 1 year, the incidence of complete relief of pain was 84.2% for pancreatectomy and 81.5% for pancreatic duct drainage. Pancreatic endocrine and exocrine functions, however, had been maintained or recovered more completely after pancreatic drainage. Operative procedures should be selected for the individual patient by considering the degree of pancreatic duct dilatation and location of the pancreatic lesions as well as the effect of pain relief and maintenance of pancreatic function.

Key words
pancreatic duct drainage, pancreatectomy, pancreatic endocrine and exocrine functions

Reprint requests
Shuji Isaji First Department of Surgery, Mie University School of Medicine
2-174 Edobashi, Tsu, 514 JAPAN

Accepted
July 3, 1991

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