105 patients with
intractable pain due to
chronic pancreatitis were selected for treatment by lateral pancreatico-
jejunostomy (according to the procedure of Partington Rochelle) after pre operative endoscopy had revealed a dilatation of the main pancreatic duct (mean : 6 mm). Pancreatico-
jejunostomy was the unique procedure in 59 patients; it was associated with a biliary or duodenal diversion in 46 others patients. 2 patients died post-operatively and 12 required a second operation some years subsequent to the pancreatic drainage, for biliary
stenosis due to the progress of the
sclerosis. 8 of the 22 late death were in direct relation with the persistence of alcohol intake and 4 others died from an extra
pancreatic cancer.
Peptic ulcer complicating pancreatico-
jejunostomy appeared in three patients and two of them died from
hemorrhage. Mean observation time was 65 years. Long term results were excellent or improved in 93.4% what
pain relief concern, but the progression of exocrine or endocrine
pancreatic insufficiency indicates that
decompression of the dilated pancreatic duct does not prevent continuing destruction of pancreatic glandular tissue. In spite of these good results, the rational for duct drainage as a mean to decrease the intraductal pressure secondary to
stricture is unclear. Neither the patency of the anastomosis, nor the presence or not of pancreatic
lithiasis or the size of the dilated pancreatic duct seem to be crucial for
pain relief after pancreatico-
jejunostomy. Notwithstanding of the dubiousness of the mechanism of action of the drainage procedure, pancreato-
jejunostomy remains the most effective procedure for relief of
pain in
chronic pancreatitis with dilated duct.