[Severe chronic parenchymatous pancreatitis: surgical treatment by wirsungo-sphincteroclasia. Original technique: 92 cases]. / Pancréatite chronique parenchymateuse sévère: traitement chirurgical par wirsungo-sphinctéroclasie. Technique originale: 92 cas.

ABSTRACT

Since october 1986, we have performed 92 wirsungo-sphincteroclasias (W-SC) in patients with severe chronic pancreatitis who did not have dominant cavity formation (which can be managed by simple cyst-duodenostomy) and presented dilatation (even moderate) of the Wirsung's duct. This novel technique involves identification of the biliopancreatic outlet by biliary spincteroclasia followed by short cephalic wirsungotomy. This method allows desobstruction of the duct both upstream and downstream followed by drilling and calibration of the duct and the ampula to 9 to 11 mm. The wirsungotomy is then sutured and a temporary naso-wirsung drain is installed instead of a wirsungojejunal Y anastomosis. Biliodigestive anastomosis was also required in 64 cases using a Vankemmel cholecystoplasty in all cases except 2 (prior cholecystectomy). Duodenoplasty and gastrojejunostomy were also required in 4 and 3 cases respectively. There were no post-operative deaths and pancreatic fistulization was never observed. The mean hospital stay after surgery was 12.2 days. Long-term follow-up at 3 to 33 months showed 6 reoperations (W-SC) and 5 more cases of biliodigestive anastomosis. Actuarial survival at 5 years was 81.5% with 90.7% good and excellent results with weight gain in 50% of the cases. The rate of diabetes degradation was better than with other treatment modalities. These very encouraging results have led us to abandon the more classical techniques of exeresis or pancreatojejunal drainage into an excluded loop in favor of W-SC for chronic parenchymatous pancreatitis or cyst-duodenostomy for chronic cavitary pancreatitis. The procedure is associated with a biliodigestive anastomosis using the Vankemmel plasty in about two-thirds of the cases.