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

ABSTRACT

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.