Different surgical strategies for chronic pancreatitis significantly improve long-term outcome: a comparative single center study

Hildebrand P, Dudertadt S, Czymek R, Bader Fg, Roblick Uj, Bruch H-P, Jungbluth, Jungbluth T

Description

Objective In general, chronic pancreatitis (CP) primarily requires conservative treatment. The chronic pain syndrome and complications make patients seek surgical advice, frequently after years of progression. In the past, surgical procedures involving drainage as well as resection have been employed successfully. The present study compared the different surgical strategies. Patients and Methods From March 2000 until April 2005, a total of 51 patients underwent surgical treatment for CP at the Department of surgery, University of Schleswig-Holstein, Campus Lübeck. Out of those 51 patients, 39 (76.5%) were operated according to the Frey procedure, and in 12 cases (23.5%) the Whipple procedure was performed. Patient data were documented prospectively throughout the duration of the hospital stay. The evaluation of the postoperative pain score was carried out retrospectively with a validated questionnaire. Results Average operating time was 240 minutes for the Frey group and 411 minutes for the Whipple group. The medium number of blood transfusions was 1 in the Frey group and 4.5 in the Whipple group. Overall morbidity was 21% in the Frey group and 42% in the Whipple group. 30-day mortality was zero for all patients. During the median follow-up period of 50 months, an improvement in pain score was observed in 93% of the patients of the Frey group and 67% of the patients treated according to the Whipple procedure. Conclusion The results show that both the Frey procedure as well as partial pancreaticoduodenectomy are capable of improving chronic pain symptoms in CP. As far as later endocrine and exocrine pancreatic insufficiency is concerned, however, the extended drainage operation according to Frey proves to be advantageous compared to the traditional resection procedure by Whipple. Accordingly, the Frey procedure provides us with an organ-preserving surgical procedure which treats the complications of CP sufficiently, thus being an alternative to partial pancreaticoduodenectomy if there is no suspicion of malignancy.

Sujets

• Chronic pancreatitis
• Frey's procedure
• Pancreaticoduodenectomy

Informations

• Publié par: biomed
• Publié le: 01 janvier 2010
• Nombre de lectures: 7
• Langue: English

Extrait

aUGUsT 20, 2010

EUr J Med Res (2010) 15: 351-356

EuRoPEan JouRnal of MEDIcal RESEaRcH

351 © I. HOLzàpFeL PUbLishers 2010

D IffEREnt S uRgIcal S tRatEgIES foR c HRonIc P ancREatItIS S IgnIfIcantly I MPRovE l ong - tERM o utcoME : a c oMPaRatIvE S InglE c EntER S tuDy

1 21 11 11 P. HiLdebràNd, S. DUderTàdT, R. czYmek, f. g. Bàder, u. J. RObLiCk, H.-P. BrUCh, t. JUNGbLUTh

1 2 DepàrTmeNT OF SUrGerY àNdDepàrTmeNT OF INTerNàL MediCiNe, uNiVersiTY OF SChLeswiG-HOLsTeiN, càmpUs lübeCk, germàNY

Abstract Objective:IN GeNeràL, ChrONiC pàNCreàTiTis (cP) primàr- iLY reqUires CONserVàTiVe TreàTmeNT. the ChrONiC pàiN sYNdrOme àNd COmpLiCàTiONs màke pàTieNTs seek sUrGi- CàL àdViCe, FreqUeNTLY àFTer Yeàrs OFprOGressiON. IN The pàsT, sUrGiCàL prOCedUres iNVOLViNG dràiNàGe às weLL às reseCTiON hàVe beeN empLOYed sUCCessFULLY. the pre- seNT sTUdY COmpàred The diFFereNT sUrGiCàL sTràTeGies. Patients and Methods:frOm MàrCh 2000 UNTiL apriL 2005, à TOTàL OF51 pàTieNTs UNderweNT sUrGiCàL TreàT- meNT FOr cP àT The DepàrTmeNT OFsUrGerY, uNiVersiTY OF SChLeswiG-HOLsTeiN,càmpUs lübeCk. oUT OFThOse 51 pàTieNTs, 39 (76.5%) were OperàTed àCCOrdiNG TO The freY prOCedUre, àNd iN 12 Càses (23.5%) The WhippLe prOCedUre wàs perFOrmed. PàTieNT dàTà were dOCU- meNTed prOspeCTiVeLY ThrOUGhOUT The dUràTiON OFThe hOspiTàL sTàY. the eVàLUàTiON OFThe pOsTOperàTiVe pàiN sCOre wàs Càrried OUT reTrOspeCTiVeLY wiTh à VàLidàTed qUesTiONNàire. Results:aVeràGe OperàTiNG Time wàs 240 miNUTes FOr The freY GrOUp àNd 411 miNUTes FOr The WhippLe GrOUp. the mediUm NUmber OFbLOOd TràNsFUsiONs wàs 1 iN The freY GrOUp àNd 4.5 iN The WhippLe GrOUp. oVeràLL mOrbidiTY wàs 21% iN The freY GrOUp àNd 42% iN The WhippLe GrOUp. 30-dàY mOrTàLiTY wàs zerO FOr àLL pàTieNTs. DUriNG The mediàN FOLLOw-Up periOd OF50 mONThs, àN imprOVemeNT iN pàiN sCOre wàs ObserVed iN 93% OFThe pàTieNTs OFThe freY GrOUp àNd 67% OF The pàTieNTs TreàTed àCCOrdiNG TO The WhippLe prOCe- dUre. Conclusion:the resULTs shOw ThàT bOTh The freY prOCe- dUre às weLL às pàrTiàL pàNCreàTiCOdUOdeNeCTOmY àre CàpàbLe OFimprOViNG ChrONiC pàiN sYmpTOms iN cP. as Fàr às LàTer eNdOCriNe àNd exOCriNe pàNCreàTiC iN- sUFFiCieNCY is CONCerNed, hOweVer, The exTeNded dràiNàGe OperàTiON àCCOrdiNG TO freY prOVes TO be àd- VàNTàGeOUs COmpàred TO The TràdiTiONàL reseCTiON prO- CedUre bY WhippLe. aCCOrdiNGLY, The freY prOCedUre prOVides Us wiTh àN OrGàN-preserViNG sUrGiCàL prOCe- dUre whiCh TreàTs The COmpLiCàTiONs OFcP sUFFiCieNTLY, ThUs beiNG àN àLTerNàTiVe TO pàrTiàL pàNCreàTiCOdUO- deNeCTOmY iFThere is NO sUspiCiON OFmàLiGNàNCY.

Key words:chrONiC pàNCreàTiTis – freY prOCedUre – WhippLe OperàTiON – PàiN sCOre

I ntRoDuctIon

chrONiC pàNCreàTiTis (cP) is àN iNFLàmmàTOrY prOCess LeàdiNG TO iNCreàsiNG àNd irreVersibLe dàmàGe OF pàreNChYmàL FUNCTiON. WiTh àN iNCideNCe OF 4/100,000/Yeàr àNd à preVàLeNCe OF13/100,000, cP is à reLàTiVeLY ràre diseàse [1]. ETiOLOGiCàLLY The màjOriTY OF Càsesis TràCed bàCk TO àLCOhOL àbUse, wiTh dàTà VàrYiNG beTweeN 55% àNd 80% [1-3]. the remàiNiNG perCeNTàGes àre CLàssiFied às idiOpàThiC, siNCe Their Ori- GiN is UNkNOwN [3]. the spONTàNeOUs COUrse wiTh respeCT TO pàiN deVeL- OpmeNT àNd The OCCUrreNCe OFeNdOCriNe àNd exOCriNe iNsUFFiCieNCY is VàriàbLe. the TwO màiN màNiFesTàTiONs àre reCUrreNT àTTàCks OFàbdOmiNàL pàiN àNd prOGres- siVe iNsUFFiCieNCY OFeNdOCriNe àNd exOCriNe OrGàN FUNCTiON. DrUG TheràpY OFcP FOCUses ON TreàTmeNT OF àbdOmiNàL pàiN sYmpTOms, TreàTmeNT OFexOCriNe iN- sUFFiCieNCY iNCLUdiNG preVeNTiON OFweiGhT LOss, sTàbi- LizàTiON OFThe meTàbOLiC CONdiTiON, preVeNTiON OFdis- eàse prOGressiON às weLL às preVeNTiON OFCOmpLiCà- TiONs. fiNàLLY, The psYChOsOCiàL Càre OFpàTieNTs, espe- CiàLLY CONsideriNG àN àLCOhOL prObLem hàs TO be CON- sidered [4]. aFTer The diseàse hàs prOGressed FOr Yeàrs Or eVeN deCàdes, The LimiT OFàNàLGesià is reàChed iN màNY Càses àNd iN àddiTiON TO The seVere LONG-Term pàiN, OrGàN COmpLiCàTiONs OCCUr whiCh CàNNOT be màNàGed CONserVàTiVeLY Or iNTerVeNTiONàLLY. these iN- CLUde biLe dUCT sTeNOsis, dUOdeNàL sTeNOsis, pOrTàL VeiN CONsTriCTiON wiTh pOrTàL hYperTeNsiON, FOrmàTiON OF pseUdOCYsTs, pàNCreàTiC NeCrOses, pàNCreàTOGeNiC às- CiTes àNd The FOrmàTiON OFpàNCreàTiC FisTULàs [5]. IN àL- mOsT eVerY OTher pàTieNT, sUrGerY is iNdiCàTed dUe TO The prOGressiON OFThe diseàse [6]. there is NO sTàN- dàrd sUrGiCàL prOCedUre ThàT CàN àLwàYs sUFFiCieNTLY meeT àLL OFThese CriTerià àNd CONsider àLL iNdiVidUàL speCiàL ChàràCTerisTiCs àNd COmpLiCàTiONs àssOCiàTed wiTh The diseàse. aCCOrdiNG TO exisTiNG pàThOphYsiO- LOGiCàL CONCepTs, Three OperàTiVe meThOds hàVe be- COme mOsT COmmON iN sUrGiCàL TheràpY: TeChNiqUes iN- VOLViNG dUCT dràiNàGe, ràdiCàL reseCTiVe sUrGerY àNd LO- CàL reseCTiONs. the preseNT sTUdY dOCUmeNTed The dàTà OF àLLpàTieNTs OperàTed ON FOr cP àNd COmpàred The diFFereNT reseCTiVe sUrGiCàL sTràTeGies wiTh respeCT TO diFFereNT pàràmeTers.