Total Pancreatectomy for the Treatment of Chronic Pancreatitis: Indications, Outcomes, and Recommendations

Behrman, Stephen W.; Mulloy, Matthew
April 2006
American Surgeon;Apr2006, Vol. 72 Issue 4, p297
Academic Journal
Total pancreatectomy (TP) for chronic pancreatitis (CP) has not gained widespread acceptance because of concerns regarding technical complexity, diabetic complications, and uncertainty with respect to long-term pain relief. Records of patients having TP from 1997 to 2005 were reviewed, Patient presentation, etiology of disease, and the indication for TP were examined, Operative results were analyzed. Long-term results were critically assessed, including narcotic usage and the need for re-admission. Postoperative quality of life (QOL) was assessed by the SF-36 health survey. During the study period, 7 patients with CP had TP, and 28 had other operations. The etiology of CP was alcohol in four and hereditary pancreatitis in three. The indication for surgery was pain and weight loss. Preoperatively, all patients used narcotics chronically and two had insulin-dependent diabetes. Four had TP after failed previous surgical procedures. Endoscopic retrograde cholangiopancreatography and computed tomography demonstrated small ducts and atrophic calcified glands. The mean length of the operation was 468 minutes, and only two patients required transfusion. There were no biliary anastomotic complications. The mean length of stay was 14 days. Major morbidity was limited to a single patient with a leak from the gastrojejunal anastomosis. Thirty-day mortality was zero, with one late death unrelated to the surgical procedure or diabetes. The mean length of follow-up was 40 months. All patients remained alcohol and narcotic free. No patient was readmitted with a diabetic complication. When compared with the general population, QOL scores were diminished but reasonable. We conclude that TP is indicated in hereditary pancreatitis and in those with an atrophic, calcified pancreas with small duct disease; that TP is technically arduous but can be completed with very low morbidity and mortality; and that on long-term follow-up, pain relief and abstinence from alcohol and narcotics was excellent with an acceptable QOL.


Related Articles

  • A case of acute pancreatitis: could this be caused by dermal filler injections? Lucas-Herald, AK; Jamieson, NB; Roxburgh, CS // Journal of Surgical Case Reports;Aug2012, Vol. 2012 Issue 8, p5 

    The use of dermal fillers is increasingly common. Side effects associated with their use are usually limited to local reactions. Acute pancreatitis is also a common condition with a wide range of aetiologies. To date, no potential associations between acute pancreatitis and dermal filler...

  • Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence. Isaji, Shuji // Journal of Hepato -- Biliary -- Pancreatic Sciences;Nov2010, Vol. 17 Issue 6, p763 

    Introduction: For the surgical management of chronic pancreatitis with an inflammatory pancreatic head mass, extended drainage operations such as Beger and Frey procedures were established in the 1980s as an alternative to resectional procedures like pancreaticoduodenectomy and as opposed to...

  • Clinical: Red flag symptoms - Epigastric pain. Mathukia, Mehul // GP: General Practitioner;8/20/2010, p33 

    The article reports on the causes and diagnosis of epigastric pain. The pain is said to be common and causes range from the benign, such as indigestion, to life-threatening conditions including MI. It reports that a burning or gnawing pain may be suggestive of gastritis or peptic ulcer disease...

  • Chronic pelvic pain: causes, mechanisms and effects. Cambitzi, Julia // Nursing Standard;1/19/2011, Vol. 25 Issue 20, p35 

    This article outlines the causes, mechanisms and effects of chronic pelvic pain. It provides a basic overview of the biopsychosocial treatment options delivered by a multidisciplinary team. The focus is on actively listening to patients to validate their pain experience and provide information...

  • Orofacial Pain in Cancer: Part II--Clinical Perspectives and Management. Epstein, J. B.; Elad, S.; Eliav, E.; Jurevic, R.; Benoliel, R. // Journal of Dental Research;Jun2007, Vol. 86 Issue 6, p506 

    Cancer-associated pain is extremely common and is associated with significant physical and psychological suffering. Unfortunately, pain associated with cancer or its treatment is frequently under-treated, probably due to several factors, including phobia of opioids, underreporting by patients,...

  • Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Daniel K Mullady // Gut;Jan2011, Vol. 60 Issue 1, p77 

    OBJECTIVE: To compare patients with chronic pancreatitis (CP) with constant pain patterns to patients with CP with intermittent pain patterns. METHODS: This was a prospective cohort study conducted at 20 tertiary medical centers in the USA comprising 540 subjects with CP. Patients with CP were...

  • Novel Therapeutic Targets for Acute Pancreatitis and Associated Multiple Organ Dysfunction Syndrome. M. Bhatia // Current Drug Targets - Inflammation & Allergy;Dec2002, Vol. 1 Issue 4, p343 

    Acute pancreatitis is a common clinical condition. The exact mechanisms by which diverse etiological factors induce an attack are unclear but once the disease process is initiated, common inflammatory and repair pathways are invoked. Acinar cell injury early in acute pancreatitis leads to a...

  • Acute pancreatitis in children DeBanto, John R.; Goday, Praveen S.; Pedroso, Martha R.A.; Iftikhar, Rehan; Fazel, Ali; Nayyar, Sanjay; Conwell, Darwin L.; DeMeo, Mark T.; Burton, Frank R.; Whitcomb, David C.; Ulrich II, Charles D.; Gates Jr, Lawrence K. // American Journal of Gastroenterology;Jul2002, Vol. 97 Issue 7, p1726 

    OBJECTIVES:Currently, there is no scoring system for predicting severity in acute pancreatitis in children. Our intent was to evaluate the performance of existing scoring systems in children, to develop a system for children, and to examine the etiology of acute pancreatitis in...

  • An unusual cause of acute pancreatitis? Noun, R.; Zeidan, S.; Riachy, E.; Honein, K. // Gut;Jan2007, Vol. 56 Issue 1, p42 

    A quiz concerning an unusual cause of acute pancreatitis is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics