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Introduction: Debilitating abdominal pain remains the most common presentation of chronic pancreatitis and the treatment remains challenging. This study analyzed the outcome of surgery in patients with chronic pancreatitis.
Patients and methods: We retrospective reviewed details of patients undergoing surgery for chronic pancreatitis between January 2002 and June 2013 at Division of Surgical Gastroeneterology, PGIMER, Chandigarh . A total of 60 patients were admitted for surgery, however, surgery was not performed in five due to medical reasons.Indications for surgery was pain in 51patients, gastric outlet obstruction in 2 and bleeding in 2 patients.
Results.38/60 were males and mean age was 37(SD± 12.94).22 patients were alcoholics and 17 were smokers.47 patients were on oral and 10 patients were on intravenous analgesics while 3 did not require regular analgesics.10 patients had diabetes mellitus and 11 had steatorrhea preoperatively.39 patients underwent Frey's procedure while Whipple's procedure was done in 6 and Izbicki's procedure was done in two. LPJ was done in two while bipolar ligation and distal pancreatectomy with splenectomy(for splenic artery pseudo aneurysm) was done in another two. Roux-en-y cystojejunostomy performed in 2. Three patients underwent reoperation for poor pain control; 2 patient with LPJ done previously underwent Frey's procedure after 2 years while one patient who had undergone Frey's procedure underwent Whipple's procedure after 4 years.
There were no in hospital mortalities. 4 patients died during follow up; cause being alcoholic cirrhosis in 2, suicide in 1 and diabetic ketoacidosis with sepsis in another. Two patients had postoperative intraluminal bleed and one needed re-exploration. After a mean follow up of 23.9 months ± SE 23.6 months (median: 13 months; range 1 to 84 months) ; 54 % of patients reported excellent pain relief, 20% patients reported good pain relief and 11.4% patients had fair pain relief(on regular oral pain killers). Two patients developed new onset diabetes controlled by diet and medications, while in 4 patients diabetes worsened.5 patients had new onset stetorrhea which was transient in all and settled with dietarymodification in two and enzyme supplementation in another three.
Conclusions:Tailored surgery for chronic pancreatitis has excellent benefit in pain relief without significant increase in functional abnormalities. Frey's procedure was the commonest surgery performed in the present study.