Operative management of chronic pancreatitis in children.

ABSTRACT

HYPOTHESIS: Chronic pancreatitis in childhood is a rare but potentially debilitating disorder, and failure of conservative therapy with chronic pain medication use is common. We hypothesize that aggressive surgical therapy may hold promise for long-term remission. DESIGN: Retrospective analysis of data collected prospectively for 12 years. SETTING: Tertiary care children's hospital. PATIENTS Eighteen children (aged 3-13 years, 11 girls) underwent surgical treatment of chronic pancreatitis after 1 to 6 years of various medical therapies (parenteral nutrition, somatostatin, or pain medication). These patients required a mean +/- SD 6 +/- 0 hospitalizations before operation. Pancreatitis was familial in 9 patients, idiopathic in 5, and secondary to trauma and medication use in 2 each. Preoperative endoscopic retrograde cholangiopancreatography showed pancreatic duct dilatation in 7, strictures in 5, ductal stones in 4, and normal findings in 2. The operative therapy consisted of longitudinal pancreaticojejunostomy in 2 children (both children failed pancreaticojejunostomy but improved after undergoing pancreatectomy) and distal pancreatectomy with Roux-en-Y pancreaticojejunostomy in 16 children. OUTCOME MEASURES: Survival, need for rehospitalization or reoperation, and chronic pain medication requirements. RESULTS: All patients survived. Follow-up ranged from 1 to 15 years. Thirteen (72%) of 18 patients have required no further hospitalizations or medications. Two patients required a second operation to convert their longitudinal pancreaticojejunostomy to distal pancreatectomy, and 3 patients have required 2 to 5 additional hospitalizations for recurrent pancreatitis. Endoscopic retrograde cholangiopancreatography on 5 patients 2 to 4 years postoperatively showed patent distal pancreaticojejunostomy. CONCLUSIONS: This series suggests that distal pancreatectomy and pancreaticojejunostomy are effective treatments for this difficult group of patients, while longitudinal pancreaticojejunostomy was ineffective. Long-term relief of pain and reduced need for rehospitalization are the usual results after this procedure.