Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy.

Abstract

OBJECTIVE:

To analyze the efficacy of extended drainage--that is, longitudinal pancreaticojejunostomy combined with local pancreatic head excision (LPJ-LPHE)-and pylorus-preserving pancreatoduodenectomy (PPPD) in terms of pain relief, control of complications arising from adjacent organs, and quality of life.

SUMMARY BACKGROUND DATA:

Based on the hypotheses of pain origin (ductal hypertension and perineural inflammatory infiltration), drainage and resection constitute the main principles of surgery for chronic pancreatitis.

METHODS:

Sixty-one patients were randomly allocated to either LPJ-LPHE (n = 31) or PPPD (n = 30). The interval between symptoms and surgery ranged from 12 months to 10 years (mean 5.1 years). In addition to routine pancreatic diagnostic workup, a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Endocrine and exocrine functions were assessed in terms of oral glucose tolerance and serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl testing. During a median follow-up of 24 months (range 12 to 36), patients were reassessed in the outpatient clinic.

RESULTS:

One patient died of cardiovascular failure in the LPJ-LPHE group (3.2%); there were no deaths in the PPPD group. Overall, the rate of in-hospital complications was 19.4% in the LPJ-LPHE group and 53.3% in the PPPD group, including delayed gastric emptying in 9 of 30 patients (30%; p < 0.05). Complications of adjacent organs were definitively resolved in 93.5% in the LPJ-LPHE group and in 100% in the PPPD group. The pain score decreased by 94% after LPJ-LPHE and by 95% after PPPD. Global quality of life improved by 71% in the LPJ-LPHE group and by 43% in the PPPD group (p < 0.01).

CONCLUSIONS:

Both procedures are equally effective in terms of pain relief and definitive control of complications affecting adjacent organs, but extended drainage by LPJ-LPHE provides a better quality of life.

• Authors: J R Izbicki, C Bloechle, D C Broering, W T Knoefel, T Kuechler, C E Broelsch
• Journal: Annals of surgery (Ann Surg) Vol. 228 Issue 6 Pg. 771-9 (Dec 1998) ISSN: 0003-4932 [Print] United States
• PMID: 9860476 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Chronic Disease
• Drainage (methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Pain (surgery)
• Pancreas (surgery)
• Pancreaticoduodenectomy (methods)
• Pancreaticojejunostomy (methods)
• Pancreatitis (surgery)
• Prospective Studies
• Pylorus
• Quality of Life