Long-term follow-up after organ-preserving pancreatic head resection in patients with chronic pancreatitis.

In chronic pancreatitis (CP), enlargement of the pancreatic head develops as a result of inflammatory alterations. This report relates to the results attained with an organ-preserving pancreatic head resection (OPPHR) in 135 patients in a 7-year period. The surgical procedure consists of a wide excision of the inflammatory tumor in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. Reconstruction, with drainage of the secretion from the remaining pancreas into the intestinal tract, takes place through a jejunal Roux-en-Y loop. Only one reoperation was required in consequence to anastomosis bleeding, but no mortality occurred in the postoperative period. The duration of hospitalization ranged between 7 and 12 days. The mean follow-up period was 4.1 years (range, 0.5-7.0). The late mortality rate was 3.7%. The quality of life, measured during the follow-up by using EORTC Quality-of-Life Questionnaire, improved in 89% of the patients. One hundred sixteen patients became complaint-free, while 14 patients had moderate symptoms; the weight increased by a median of 11.3 kg (range, 4-28). The 7-year experience clearly reveals that this OPPHR technique is a safe and effective procedure for definitive control of the complications of CP.

Organ-preserving resection of the pancreatic head in patients with chronic pancreatitis.

INTRODUCTION: In chronic pancreatitis (CP), enlargement of the head of the pancreas develops in consequence of inflammatory alterations. A new safe procedure has been developed for duodenum-preserving pancreatic head resection, and this prospective report is concerned with the results attained with this operation. PATIENTS AND METHODS: In 94 patients a new surgical management was performed after the development of an inflammatory tumour of the pancreatic head. The preoperative morbidity comprised frequent abdominal pain, a weight loss in all patients, jaundice in 8 patients, and latent and insulin-dependent diabetes mellitus in 8 and 8 patients, respectively. The diagnosis was confirmed by ERCP, sonography and CT. Pancreatic functions were checked by means of the amylium tolerance test (ATT), the glucose tolerance test and stool elastase. The surgical procedure consisted in a local resection of the inflammatory tumour in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. Reconstruction, with drainage of the secretion from the remaining pancreas into the intestinal tract, took place through a jejunal Roux-en-Y loop. In 8 icteric cases and in 12 patients with stenosis of the common bile duct, prepapillary bile duct anastomosis was also performed with the jejunal loop. RESULTS: Only one reoperation was performed, in consequence of anastomosis bleeding, but no mortality was noted in the postoperative and follow-up period. The duration of hospitalization ranged between 7 and 12 days, with a median of 8.5 days. In the median follow-up period of 24 months (range 6 to 42), all the patients became complaint-free, and the weight increased by a mean of 10 kg (range 4-25). The ATT and the stool elastase level demonstrated an exocrine function improvement, no significant change was noted in the preoperative endocrine function. CONCLUSIONS: The results clearly reveal that this organ-preserving pancreatic head resection is a safe and effective procedure for definitive control of the complications following the inflammatory alterations of CP.

Ten-year experience with duodenum and organ-preserving pancreatic head resection (Büchler-Farkas modification) in the surgical treatment of chronic pancreatitis.

OBJECTIVES: Chronic pancreatitis, a benign, inflammatory process, can cause enlargement of the pancreatic head, which is accompanied by severe pain and weight loss and often leads to a significant reduction in the quality of life (QoL). METHODS: Our clinical experience relates to the results attained with duodenum and organ-preserving pancreatic head resection in 160 patients during a 10-year period. The QoL is assessed during the follow-up period by using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire. RESULTS: Two reoperations were required in consequence of anastomosis bleeding and small bowel obstruction, but no mortality was noted in the postoperative period. The duration of hospitalization ranged between 7 and 12 days. The mean follow-up time was 5.3 years (range, 0.5-10.0 years). The late mortality rate was 6.9%. The QoL improved in 89% of the cases. One hundred thirty-three of the patients became complaint-free, whereas 16 displayed moderate symptoms, and the weight increased by a median of 13.4 kg (range, 4-30 kg). The postoperative endocrine functions remained in almost the same stage as preoperatively. CONCLUSION: Our 10-year experience clearly demonstrates that this duodenum and organ-preserving pancreatic head resection technique is a safe and effective procedure, which should be preferred in the surgical treatment of the complications of chronic pancreatitis.

Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy.

BACKGROUND AND AIMS: In a prospective, randomised, control trial organ-preserving pancreatic head resection (OPPHR) was compared with pylorus-preserving pancreaticoduodenectomy (PPPD) to assess the advantages and disadvantages of each type of operation. PATIENTS AND METHODS: Forty patients were allocated randomly to either the OPPHR (n=20) or the PPPD (n=20) group. The surgical data, postoperative complications, induction of diabetes mellitus, postoperative pain and quality of life 1 year, postoperatively, were considered. RESULTS: The two study groups of 20 patients were well balanced with regard to sex, age, chronic pancreatitis history and indication for surgery. The duration of the operation for OPPHR and PPPD was 142.5+/-4.9 and 278+/-6.9 min, respectively (P<0.05). The postoperative mortality in each group was zero. After OPPHR and PPPD, the morbidity was 0 and 40%, respectively (P<0.05). The duration of hospital stay was also significantly different: 8.05+/-0.9 vs 13.8+/-3.9 days (P<0.05). After 1 year the pain relief was effective in both groups, but three patients acquired diabetes mellitus after PPPD; the body weight had increased by 7.8+/-0.9 and 3.2+/-0.3 kg after OPPHR and PPPD, respectively (P<0.05). CONCLUSION: The two procedures are equally safe and effective with regard to pain relief, but OPPHR is superior to PPPD not only in the operation data and morbidity, but also in the quality of life 1 year postoperatively. OPPHR should be regarded as a recommended procedure in the treatment of chronic pancreatitis.