Surgical Treatment of Pancreatitis

ABSTRACT

PURPOSE:

The most common cause of acute pancreatitis is alcohol abuse, followed by gallstones and pancreatic trauma. Pancreatitis is treated nonoperatively by inhibiting the causes, which include prohibition of alcohol abuse and cholecystectomy for the removal of gallstones. However, in case of a pseudocyst formation, necrotizing pancreatitis or abscesses remained as the complications of severe pancreatitis. Adequate surgical drainage is very important for the treatment of the complications. Adequate surgical procedure for treatment of chronic pancreatitis, causing intractable pain, pseudocyst, and obstruction of pancreatic or bile ducts, should be considered, not only for the patients physical and psychological recovery from a chronically debilitating status, but also in its differentiation from a malignancy.

Between July 1997 and January 2002, a review and analysis was undertaken of 33 pancreatitis patients, who had been treated, by surgical intervention, for the complications of acute pancreatitis, chronic pancreatitis, and benign pancreatic disease.

For the treatment of the various complications in the 33 patients, 20 drainage procedures and 13 surgical resections were used. There were minor complications in 6 patients (21%), and two mortalities, one from multiple organ failure, due to necrotizing pancreatitis, and the other from a surgical complication, due to a duodenum preserving pancreatic head resection.

The timely surgical drainage, and/or debridement, is critical for patients with complications due to acute pancreatitis. It is difficult to differentiate chronic pancreatitis from a malignancy. Adequate surgical procedures for the different stati ('type oriented surgery') are required for chronic pancreatitis. A resection of cystic lesions, with the possibility of a malignancy, should be considered. We can confirm the diagnosis, and treat the disease, by adequate operative and drainage procedures, or by resection of the main lesion.