The Duodenum-Preserving Pancreatic Head Resection: An Organ-Preserving Operation in Chronic Pancreatitis

Abstract

Patients with chronic pancreatitis often develop inflammatory enlargement of the pancreatic head. This may lead to a variety of complications on pancreatic neighboring organs often necessitating pancreatic surgery. The duodenum-preserving pancreatic head resection (DPPHR) was developed in 1972 to treat pancreatic head-related complications in chronic pancreatitis. These include compression or stenosis of the common bile duct, the duodenum, the main pancreatic duct, and the retropancreatic vessels. In addition, intractable abdominal pain which does not respond to medical treatment is an indication to perform a DPPHR. The major advantage of the DPPHR is the maintenance of the stomach and the duodenum and thereby of the physiological food passage. This is achieved by subtotal resection of the pancreatic head preserving a small pancreatic head remnant along the duodenal wall. Reconstruction consists of an end-to-end or an end-to-side anastomosis between the pancreatic head remnant and the interposed jejunal loop. Between 1972 and 1993, 280 patients with chronic pancreatitis underwent a DPPHR. The indications to operate were pancreatic head enlargement (84%), main pancreatic duct obstruction (60%), common bile duct obstruction (50%), jaundice (14%), duodenal obstruction (36%) and vascular obstruction (16%). 263 patients (94%) suffered from moderate to severe abdominal pain. Hospital mortality was 1.1% (3/280), early postoperative morbidity was 27.1% and the rate of relaparotomy was 5.7%. Pancreatic fistula, intra-abdominal abscess, bleeding, and leakage of the anastomosis occurred in 4.6, 2.5, 3.2 and 1.8%, respectively. In 1992, a long-term follow-up was carried out (median follow-up 3.7 years). Late mortality was 5%. 90% of our patients had no or infrequent episodes of pain, 63% were rehabilitated professionally and 94% of the patients were satisfied with the results of the operation. From our experience we conclude that the DPPHR is an organ-preserving operation in patients with chronic pancreatitis and pancreatic head-related complications. It provides excellent short- and long-term results and should therefore be considered as a new standard operation in the surgical treatment of chronic pancratitis.