Experience with ligation of the pancreatic ducts in the treatment of chronic relapsing pancreatitis

Abstract

I T is the purpose of this paper to present experience with six patients suffering from chronic reIapsing pancreatitis who were treated by Iigation of the pancreatic duct or ducts. Experience at Wadsworth HospitaI in the past has indicated that for the most part none of the surgica1 procedures advocated for the relief of symptoms of chronic reIapsing pancreatitis in the absence of biliary tract disease, short of actuaI excision of the pancreas, has been invariabIy effective. Procedures most commonty advocated alone or in combination incIude: vagotomy, sympathectomy, sphincterotomy, gastroenterostomy with or without gastric resection, transpIantation of the common biIe duct, and caudaI pancreatico-dochojejunostomy. The fact that so many procedures are advocated for the reIief of this disease wouId seem to indicate that none is particuIarIy effective. AI1 of the surgica1 measures so far devised, short of excision, have had as their aims relief of assumed major duct obstruction, suppression of exocrine activity, or interruption of nerve fibers bearing pain impuIses. Neither the actua1 cause nor the pathoIogic physioIogy of chronic reIapsing pancreatitis is well understood. It is probably safe to say, however, that breakdown of the ductal system with the consequent reIease of activated enzymes into the pancreatic stroma is essentia1 to the production of the disease. In chronic reIapsing pancreatitis it is the presence of episodes of severe pain which make the disease subject to surgica1 intervention. It wouId appear that the pain is the resuIt of stroma digestion and irritation by activated enzymes which have escaped from the ducta system. Rich and Duff’ have reported the most