Presented to the 75th Annual Meeting of the Association of Surgeons of Great Britain and Ireland in London, UK, June 1995
Proximal pancreatoduodenectomy for chronic pancreatitis†
Version of Record online: 8 DEC 2005
Copyright © 1996 British Journal of Surgery Society Ltd.
British Journal of Surgery
Volume 83, Issue 10, pages 1433–1440, October 1996
How to Cite
Stapleton, G. N. and Williamson, R. C. N. (1996), Proximal pancreatoduodenectomy for chronic pancreatitis. Br J Surg, 83: 1433–1440. doi: 10.1002/bjs.1800831035
- Issue online: 8 DEC 2005
- Version of Record online: 8 DEC 2005
- Manuscript Received: 24 DEC 1995
A personal series is reported of 52 patients who underwent proximal pancreatoduodenectomy for severe chronic pancreatitis between 1979 and 1994. There were 13 women and 39 men of median age 42·2 (range 12–70) years. Disease predominantly affected the head of pancreas, with calcification present in 37 patients. Indications for operation were chronic pain (47 patients), obstructive jaundice (19) and duodenal stenosis (six); cancer was suspected in 12. In addition, 14 patients had a pseudocyst, two pancreatic endocrine failure and 20 exocrine failure. Aetiology was chronic alcohol abuse in 34, recurrent acute pancreatitis in five and unknown in 13. Pylorus-preserving proximal pancreatoduodenectomy was performed in 45 patients, while the remaining seven had partial gastrectomy. Drainage of a dilated distal pancreatic duct by side-to-side pancreaticojejunal anastomosis was included in 15 patients. Mean operating time was 6·2 (range 4·5–9·5) h and mean blood loss was 2·7 (range 0·2–13·0) litres. There were no hospital deaths, but three patients required a second operation and five had percutaneous drainage of infected collections. During a median follow-up of 54 months, six patients required completion distal pancreatectomy for renewed pain and four others had persistent pain. Four patients required intervention for stricture at the biliary-enteric anastomosis. Ten patients have died from causes not directly related to chronic pancreatitis. Proximal pancreatoduodenectomy is a relatively safe procedure, effectively palliating pain in 80 per cent of patients with chronic pancreatitis.