doiSerbia

Surgical treatment of pain in chronic pancreatitis

Stefanović Dejan (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Knežević Srbislav (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Đorđević Zoran (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Kerkez Mirko (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Bulajić Predrag (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Marković Ljiljana (Institut za patološku fiziologiju, Medicinski fakultet, Beograd)

INTRODUCTION: The principal indication for surgical intervention in chronic pancreatitis is intractable pain. Depending upon the presence of dilated pancreatic ductal system, pancreatic duct drainage procedures and different kinds of pancreatic resections are applied. OBJECTIVE: The objective of the study was to show the most appropriate procedure to gain the most possible benefits in dependence of type of pathohistological process in chronic pancreatitis. METHOD: Our study included 58 patients with intractable pain caused by chronic pancreatitis of alcoholic genesis. The first group consisted of 30 patients with dilated pancreatic ductal system more than 10 mm. The second group involved 28 patients without dilated pancreatic ductal system. Pain relief, weight gain and glucose tolerance were monitored. RESULTS: All patients of Group I (30) underwent latero-lateral pancreaticojejunal - Puestow operation. 80% of patients had no pain after 6 month, 13.6% had rare pain and 2 patients, i.e. 6.4%, who continued to consume alcohol, had strong pain. Group II consisting of 28 patients was without dilated pancreatic ductal system. This group was subjected to various types of pancreatic resections. Whipple procedure (W) was done in 6 patients, pylorus preserving Whipple (PPW) in 7 cases, and duodenum preserving cephalic pancreatectomy (DPCP) was performed in 15 patients. Generally, 89.2% of patients had no pain 6 month after the operation. An average weight gain was 1.9 kg in W group, 2.8 kg in PPW group and 4.1 kg in DPCP group. Insulin-dependent diabetes was recorded in 66.6% in W group, 57.1% in PPW group and 0% in DPCP group. CONCLUSION: According to our opinion, DPCP may be considered the procedure of choice for surgical treatment of pain in chronic pancreatitis in patients without dilatation of pancreas ductal system because of no serious postoperative metabolic consequences.

Keywords: chronic pancreatitis, pain, Wirsung-jejunostomy, pancreatic resection