Treatment of chronic pancreatitis by longitudinal pancreaticojejunostomy

Abstract

A series of fifteen patients is presented in whom pancreaticojejunostomy was performed for chronic pancreatitis. Preoperative abdominal pain and pancreatic calcification were the most constant findings. Three modifications of the original Puestow's procedure were employed in this series. The most satisfactory technical procedure at present consists of side to side pancreaticojejunostomy with preservation of the spleen and pancreatic tail. The pancreas at operation was invariably indurated, and ductal obstruction and the chain-of-lakes phenomenon were found in thirteen cases. Microscopic examination of pancreatic tissue revealed severe degrees of atrophy and fibrosis. Good results were achieved in thirteen of the fifteen patients, as evidenced by dramatic relief of pain, often despite continued alcoholic excesses. There were no deaths in this series and no postoperative diabetes occurred. Steatorrhea was corrected by the procedure in two patients and appeared postoperatively in another. In the fibrotic, stone-containing pancreas in which ductal obstruction is the basis for persistent pain, pancreaticojejunostomy offers a physiologic means of treatment. It sacrifices little or no glandular tissue, accomplishes drainage of enzyme to the lumen of the gut, relieves obstruction and usually relieves pain.