Longitudinal pancreatico-gastrostomy: An effective means of pain control in chronic pancreatitis

Abstract

To assess the effectiveness of longitudinal pancreatico-gastrostomy (LPG) in relieving intractable abdominal pain in patients of chronic pancreatitis (CP) with dilated main pancreatic duct (MPD). This prospective study was conducted from 1997-2005 at two university-affiliated hospitals in India. Ductal decompression by LPG was performed in 30 patients (26 males, 4 females) suffering from intractable pain due to CP. The operative outcomes were classified as satisfactory and unsatisfactory according to whether the patients were completely/almost completely relieved of pain or continued to be troubled by pain. The main outcome measures were pain-relief, postoperative morbidity, and mortality. There was no postoperative mortality. Morbidity included pancreatic fistula in one patient, which closed spontaneously, gastric hemorrhage in two, prolonged ileus in one and wound infection in another. Twenty eight patients (93%) patients could be followed up till the end, the mean follow-up period being 23.8 (range 3-96) months. Operative result was satisfactory (no pain or mild pain) in 23 (82%) and unsatisfactory (moderate to severe pain) in 5 (18%) patients. Complete pain relief was seen in 14 (50%) patients. The functional results, in terms of pain relief, were better in patients who had abstained from alcohol postoperatively. LPG is a good operative procedure to relieve intractable pain in patients of CP with an MPD diameter of at least 7 mm.