Outcome of Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis.

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Abstract

Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused by obstruction of the pancreatic duct system by stones or strictures. This results in increased intraductal pressure and parenchymal ischemia. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease. We want to share our experience of surgical drainage of pancreatic duct in chronic pancreatitis in our hospital. We studied 20 cases operated in our hospital between January 2010 and October 2015. Patients were selected with pre-operative ultrasonography. Dilatation of the main pancreatic duct by at least 7 mm proximal to the obstruction were recruited for operation. We did Roux-Y lateral pancreato-jejunostomy (LPJ) for patients with obstruction of the pancreatic duct due to stricture or intraductal stones or both. We did additional distal pancreatectomy in case of stone in the tail area.We did one Frey's operation for stone and fibro-calcification of the head. We evaluated their symptoms, their duration, post-operative hospital stay and complications following surgery. We studied their pain control, recurrence and mortality during this period. We followed these patients for more than 5 years. We found 16 out of 20 patients got complete remission of the abdominal pain with no progression of their disease. Ultrasonic evidence of chronic pancreatitis have improved or resolved. Ductal diameter has decreased. They did not develop diabetes or malabsorbtion. One had a recurrence of stone in the head within a year. Three died during this follow-up period. One died three months after LPJ due to massive gangrene of the small intestine distal to LPJ and jejuno-jejunostomy and subsequent short bowel syndrome. Other two developed carcinoma of the pancreas within one year and six months after LPJ respectively. Rate of pain free survival is about 75% and recurrence is 5%. Mortality during this follow up period is 15%. In this small series, we found that surgery if done early, can have good remission of abdominal pain and can slow the progression of chronic pancreatitis in majority of patient. Patient with chronic calcific pancreatitis and diabetes are likely to have unfavorable outcome even after decompressive surgery.

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