Pancreatic head resection for sphincter of oddi dysfunction

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Introduction: Sphincter of Oddi dysfunction (SOD) is a rare cause of recurrent/chronic pain. It can involve biliary or pancreatic sphincter dysfunction. Treatment is largely medical/endoscopic, with surgical sphincteroplasty a last resort. We describe a group of patients with SOD (including some with pancreas divisum and accessory sphincter dysfunction), treated with pancreatic head resection. Methods: We audited patients undergoing pancreatic head resection for SOD in two centres (2009-2017). Data included demographics, preoperative treatments, intraoperative findings, complications, histology and duration of follow-up. A validated quality of life (QoL) score (RAND SF-36) was completed for each patient. Patients were asked to subjectively compare pain and QoL before and after surgery, and if they would recommend surgery to others. Results: Fourteen patients were included, all female, Caucasian, mean age 41.8 years. Manometry was recorded in 71.4%, abnormal in 46.2%. Sphincterotomy and pancreatic stenting had been attempted in all (mean stent attempts 3.1); 50% suffered post-ERCP pancreatitis. The operation involved pancreatic head resection, with the duodenum preserved in one, and the pylorus preserved in 13. Post-operative morbidity was 57.1%, including one Clavien-Dindo IIIa complication. There were no deaths. Mean follow-up was 17.7months. QoL scores were worse than the average population across all domains, but improved QoL and reduced pain was reported in 61.5%. 84.6% of patients would recommend surgery to others with a similar problem. Conclusion: Pancreatic head resection is an alternative where endoscopic interventions have failed, but only after careful selection. QoL improved in 61.5% of our patients and most would recommend surgery.