Surgical Treatment for Pain Relief in Chronic Pancreatitis

Abstract

The surgical treatment of pain in chronic pancreatitis remains the main problem in the treatment of this disease, in a retrospective study of 52 operations conducted for the relief of pain in 37 patients the effects on pain and endocrine and exocrine pancreatic function were analyzed. Decompression-type operations led to relief of pain in 68% (15 of 22) of patients. No significant effect on pancreatic function was observed. Partial pancreatic resection (including Whipple's procedure) reduced pain in 48% (11 of 23) but induced deterioration of endocrine function in 27% (6 of 19) and of exocrine function in 44% (10 of 23). Total or subtotal pancreatectomy effectively reduced pain in all patients (seven of seven) but necessitated total exocrine substitution and insulin dependency in all patients. Late death as a consequence of the procedure was observed in three patients. Alternatives to conventional operations are now being explored, and segmental pancreatic autotransplantation was performed in two patients with effective relief of pain and insulin independency as the early outcome. Segmental autotransplantation may be an alternative to major resection in patients who are not using alcohol and not addicted to morphine-like analgesics.

Key Words:

• Chronic pancreatitis
• diabetes mellitus
• pain
• pancreatectomy
• pancreatic insufficiency
• pancreatic transplantation