Chronic Pancreatitis

Abstract

The results of surgery for chronic pancreatitis in fifty-seven patients treated between 1958 and 1972 were reviewed. The findings have been used to outline a surgical strategy for the management of this disease.Operations on the biliary tract gave disappointing results. Biliary disease must be treated when present, but this will not always lessen chronic pancreatic pain.The surgical treatment of pseudocysts by internal drainage was uncomplicated in the short run, but almost half the patients continued to have pain months or years later.Direct operations on the pancreas are most successful in chronic pancreatitis. Sphincterotomy, splanchnicectomy, gastric operations, and caudal pancreaticojejunostomy are no longer recommended. When the pancreatic duct is dilated, longitudinal pancreaticojejunostomy (Puestow operation) will effect improvement in 80 to 90 per cent of patients. Pancreatitis localized to the tail of the gland is optimally treated by hemipancreatectomy. Subtotal (95 per cent) pancreatectomy is reserved for diffuse pancreatitis when the pancreatic duct is small or when previous longitudinal pancreaticojejunostomy is unsuccessful.