Pancreatic Duct Drainage in 100 Patients with Chronic Pancreatitis

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Abstract
Although the development of islet cell autotransplantation has focused attention on extended resections of the pancreas, drainage of a dilated pancreatic duct remains an effective means of relieving intractable pain of chronic pancreatitis. Between 1954-1980, 98 men and 2 women with chronic pancreatitis were treated for pain with ductal drainage. All patients had a history of chronic alcoholism. Pancreatic calculi were found in 68 patients. Operative procedures included: 7 caudal pancreaticojejunostomies, 42 longitudinal pancreaticojejunostomies and 54 side-to-side pancreaticojejunostomies. Two caudal pancreaticojejunostomies were converted to longitudinal pancreaticojejunostomies and 1 longitudinal pancreaticojejunostomy required revision. The operative mortality rate was 4%. Follow-up studies, lasting up to 24 yr, were conducted for all but 7 patients. Eighty percent of these patients have had substantial improvement or complete resolution of their pain. Diabetes, as evidenced by an elevated fasting blood sugar level, was present prior to operation in 30% of the patients and developed after operation in 14%. Only 9 of 21 insulin-dependent diabetics in this series did not require insulin prior to pancreaticojejunostomy. Pancreatic enzyme replacement was needed for control of steatorrhea in 18 patients. Four patients with continued pain underwent total or near total pancreatectomies. Three of these patients died of uncontrolled diabetes. Only 1 patient with a drainage procedure alone has died of uncontrolled diabetes. In patients with dilated pancreatic ducts, pancreaticojejunostomy is a safe, reliable means of providing pain relief, with minimal loss of endocrine and exocrine function.