A Comparison of Pancreatectomy and Pancreatic Duct Drainage in Chronic Pancreatitis

Surgical therapy was performed in 25 cases of chronic pancreatitis at the Second Department of Surgery, Hiroshima University School of Medicine from January 1973 to October 1984. Thirteen cases were considered related to the excessive intake of alcoholic drinks, 2 cases each to acute pancreatitis and gall stones, and 8 cases to unknown etiology. Complication of pancreatic stone and marked dilatation or partial constriction of the pancreatic duct were observed in 11 of the 25 cases. Pancreaticoduodenectomy was performed in 7 cases, distal pancreatectomy in 8 cases, longitudinal pancreaticojejunostomy in 6 cases, and pancreaticoplasty in 2 cases, and biliary surgery in 2 cases. Out of 21 cases with abdominal pains, pain disappeared in 12 cases, improved in 6 cases and remained uncharged in 3 cases, the effect from surgery being almost satisfactory. No difference was observed in the effect between the surgical procedure as described above. Endocrine function tests with 50 g OGTT revealed improvement in 2 cases and aggravation in another two cases. The function remained unchanged before and after operation in the remaining 21 cases. Pancreatic exocrine function tests with PFD revealed almost no changes before and after operation and no difference between the surgical procedures. Pancreatic exocrine function was found correlated with the advanced conditions of pancreatic fibrosis rather then with the surgical procedures. Cases with less advanced fibrosis maintained the function in a more satisfactory condition both before and after operation. There occurred no cases of death directory related to operation. Four cases of death, no relating to operation itself, were observed in the pancreatectomy group. Twenty cases are now under rehabilitated conditions. Results of our surgical treatment for chronic pancreatitis are almost satisfactory in respect to pain-relieving effect but unsatisfactory in respect to improvement of the endocrine and exocrine function. It may be necessary to consider surgical operation at an early stage before the aggravation of fibrosis, because various types of drainage procedures that aim at preserving the pancreatic tissue and reducing the pancreatic duct pressure are logically capable of improving pancreatic functions