Comparative Study of Different Types of Pancreatic Head Resection for Chronic Pancreatitis

Abstract

For the surgical treatment of chronic pancreatitis with inflammatory head enlargement, several types of resections are available, like the Beger, Frey, Berne, and Whipple procedures. The present work gives a comparison of these techniques and new recommendations about the pancreatojejunal and the biliary anastomosis. Two hundred thirty pancreatic head resections were performed during the last 30 years. Pre-, intra-, and postoperative data were analyzed, respectively. A questionnaire was used to investigate the late results. The statistical analysis proved that the Berne and the Frey procedure were the most advantageous regarding the length of the operation, the need for transfusion, the postoperative intensive care unit, and total hospital stay. The early morbidity rate was significantly better after the Frey, than after the Whipple procedure. There were no differences between the operations, concerning the reoperation and mortality rates. Patients’ quality of life was acceptable, despite the continuous alcohol and nicotine abuse in most of them. Due to the better early outcomes, both the Frey and the Berne operations are preferable; however, the latter one is technically the simplest and the shortest intervention. During both procedures, a modification of the pancreatojejunal anastomosis and, in case of a cholestasis, an extrapancreatic biliodigestive anastomosis are recommended, due to the advantageous experiences.