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Surgery for chronic pancreatitis Abstract: There is a lack of consensus regarding the best treatment for chronic pancreatitis. The condition usually presents with pain and as very little can be done to change the natural history of the disease. Our efforts are directed at improving the quality of life of the patients. The most common associated etiological factor is alcohol addiction or abuse. There is evidence that pollutants or xenobiotics play a role in the pathophysiology of alcoholic CP, and these xenobiotics are often associated with occupations commonly filled by the economically disadvantaged, making rehabilitation more difficult. CP is a benign condition, however we must focus on the outcomes of therapy as for a palliative procedure. Thus durability of pain relief and improved quality of life are essential. Many reports in the literature have relatively short periods of follow up encouraging those who do not favour surgery to be sceptical of its benefits. Ductal hypertension does not explain the mechanism of pain in all patients, reflected in the failure of simple duct decompression to relieve the pain in certain cases. Parenchymal hypertension gives rise to a compartment syndrome, which is aggravated by pancreatic stimulation resulting in further ischaemia of the neurons. Disordered neo-proliferation of neurons sensitive to ischaemia produces pain. The head of the pancreas is regarded as the pacemaker for the pain. There is immunological evidence that the disease in the head of the pancreas may drive the inflammation process. Most would agree that the surgical treatment of pain in CP should only be considered when other causes of the pain have been excluded and after adequate attempts at medical therapy have failed. This presentation reviews a series of 64 patients who underwent a frey type duodenal preserving head resection with a mean follow up of 48 months and relief of pain in more than 90%. We also review a series of 54 patients with pseudocysts due to chronic pancreatitis, treated surgically with a follow up of 26 months and a 5% recurrence rate. We also present a series of 26 patients with pancreatic duct disruption treated endoscopically with 80% technical success rate but only a 63% success rate in treating the pseudocyst. This data is collated and an approach to chronic pancreatitis is discussed. |
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