Background: Surgery for pain in patients with chronic pancreatitis (CP) can be divided into resection and drainage procedures. It is assumed that resection will deteriorate exocrine and endocrine function but little is known on the effect of drainage procedures on pancreatic function.
Methods: We have prospectively evaluated pancreatic function before and after operation in 27 patients with CP who underwent duodenum preserving resection of the pancreatic head (DPRHP; age 51± 2 yr),12 CP patients who underwent pancreatico-jejunostomy (age 55± 3 yr) as drainage procedure and 18 CP patients served as controls (age 52± 2 yr). Exocrine function was evaluated by fecal fat excretion (N<7 g/24 h) and urinary PABA recovery (N> 50%),endocrine function by oral glucose tolerance test. Duration of CP symptoms (5± 1, 4± 1 and 4± 1 yr resp) and morphology score (3.4± 0.2, 3.8± 0.2 and 3.2± 0.3 resp; Cambridge-classification, range 0-4) were not different between the three groups. DPRHP was performed for pain relief when an inflammatory mass in the pancreatic head was present. Drainage was performed for pain relief when the pancreatic duct was dilated.
Results: Mean interval between the two function test was not different in the three groups:1.3± 0.3 vs 1.2± 0.3vs 1.6± 0.3 yr. Urinary PABA recovery was not affected: DPRHP from 37± 4 to 33± 4% (pre to post, ns) pancreatico-jejunostomy from 44± 5 to 40± 5% (ns) and controls from 38± 5 to 43± 4%, ns). Neither was fecal fat: DPRHP 10± 2 to 12± 2 g/24h (ns) drainage 12± 3 to 10± 3 g/24h (ns) and controls 13± 1 to 12± 1 g/24h(ns). Whereas endocrine function deteriorated after DPRHP (peak glucose from 12± 1 to 15± 1 mmol/l; p<0.01), after drainage the endocrine function improved (peak glucose from 12± 1 to 10± 0.5 mmol/l; p<0.05) and was not affected in controls (12± 1 to 12± 1 mmol/l). After DPRHP 3 patients (10%) became insulin dependent versus 0% in the drainage group.
Conclusions: Surgery for chronic pancreatitis does not influence exocrine pancreatic function but significantly affects endocrine function with improvement after drainage procedure but deterioration after pancreatic head resection.