Abstracts
1997 Digestive Disease Week

Outcome of lateral pancreaticojejunostomy in the management of chronic pancreatitis with non-dilated pancreatic ducts.

G Rios*, KG Yeoh§, P Tarnasky§, J Cunningham§, R Hawes§, P Cotton§, D Adams*. Department of *Surgery, Division of Gastroenterology and Hepatology, §Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina.

Background and Aims: Lateral pancreaticojejunostomy (LPJ) has been successful in the management of chronic pancreatitis (CP) associated with pancreatic ductal dilation, but its role in CP patients with non-dilated ducts is poorly defined. The aim of this study was to evaluate the results of LPJ in CP patients with intractable pain associated with non-dilated pancreatic ducts. Methods: A consecutive series of 17 patients who underwent LPJ for intractable pain due to CP with a pancreatic duct <7 mm in diameter were reviewed. Basic demographic, peri-operative complications, and outcome measurement data were collected. Quality of life (QOL) questionnaires were administered in person or by telephone and included questions on frequency of attacks, pain score (0 to 10), number of medical encounters before and after LPJ, and a 5 point Likert scale to assess change in health status and satisfaction with care received. Results: Seventeen patients (11 females, 6 males; mean age 36.9 years, range 24-48) underwent LPJ between 1995-1996. Eight patients had a diagnosis of sphinter of Oddi dysfunction based on sphincter manometry studies, 5 patients had a history of alcohol abuse, 3 had pancreas divisum, and 1 was considered familial. ERCP ductography showed features of moderate CP in 10 patients, mild CP in 6, and severe CP in 1,as defined by the Cambridge classification. All patients had failed extensive medical and endoscopic treatment to control pain and recurrent pancreatitis. Early post-operative complications occurred in 2 patients (11.7%) and included 1 drain track infection and 1 external pancreatic fistula. There were no deaths. Follow-up ranged from 3-16 months (mean=10.3). Rehospitalizations for recurrent pancreatitis or pain was necessary in 59% of patients. Emergency room visits were reported by 76% of the patients. Narcotic use continued in 88% of the cases even though 24% of patients characterized their pain as better compared to pre-operative pain. Seventy-six percent of the patients reported their pain as the same or worse than before the LPJ, and 65% continued to view their health status as poor. Four patients have required further operations. Conclusions: In CP patients with a non-dilated pancreatic duct, LPJ appeared to be of no benefit with respect to pain relief, subsequent hospitalization, continued narcotic use, or overall health status as perceived by the patient.