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Introduction: Resection and drainage procedures achieve long-term pain relief in approximately 80% of patients with chronic pancreatitis. In the 20% of patients who develop recurrent pain following failed primary operation, little data exists on effective treatment options. This study reports our experience with reoperation for recurrent pain following failed primary operation in patients with chronic pancreatitis.
Methods: Over 18 years (1988 - 2006), 316 pts. with histopathologically verified chronic pancreatitis underwent primary operation to achieve pain relief. Etiologies of chronic pancreatitis included: ETOH (38%), pancreas divisum (30%), idiopathic (25%), and miscellaneous (7%). Primary operations included: pancreaticoduodenectomy [PD] (N=100), duodenum preserving pancreatic head resection [DPPHR] (N=53), Peustow pancreaticojejunostomy [PPJ] (N=51), and distal pancreatectomy [DP] (N=112). Forty patients (13%) who failed primary operation had reoperations for pancreatic duct strictures (N=25), biliary strictures (N=6) or parenchymal disease progression (N= 9) identified by radiographic imaging (CT, MRCP, EUS, ERCP) and were retrospectively reviewed.
Results: Table 1.
Conclusions: In reoperations, TP achieves the best pain relief (83%) at a high cost of new endocrine insufficiency. Revision operations have a low morbidity, less endocrine insufficiency, and a 50% incidence of pain relief. Pancreatic head resections (DPPHR, PD) are less effective (25%, 13% pain relief) than when used as the primary operation.
Table 1

Reoperation	N	Morbidity‡ > IIIa	New endocrine insuff.	Pain relief
TP	7	2 (29%)	5 (71%)	83%
Revision	14	1 (7%)	2 (14%)	50%
DP	3	2 (67%)	1 (33%)	50%
DPPHR	8	2 (25%)	2 (25%)	25%
PD	8	3 (38%)	3 (38%)	13%

‡Grading system of DeOliveira (Ann Surg 2006:244:931-9.) TP = total pancreatectomy

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