Drainage operations in chronic pancreatitis

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Abstract
If pancreatic ductal hypertension explained the pain of chronic pancreatitis, adequate decompression of ectatic ducts should provide lasting relief. We have analysed a personal series of 20 patients (14 men and 6 women) with chronic pancreatitis undergoing one or more drainage procedures. Alcohol was the main aetiological factor, and symptoms had been present for a median of 2.5 years. Pancreatic ductal decompression was achieved by pancreatic sphincteroplasty (n = 4) or longitudinal pancreaticojejunostomy (11). Thirteen patients underwent incidental or additional procedures to decompress the biliary tree: sphincteroplasty (5), choledochal bypass (7) and T-tube drainage (1). Cysts were either drained (7) or resected (3). Two patients required re-operation for subphrenic abscess. Some pancreatic insufficiency was detected pre-operatively in 11 patients (exocrine 10, endocrine 4) and was essentially unchanged in all but one patient who came to total pancreatectomy. Two other patients required a coeliac plexus block, but the remaining 17 patients had good pain relief at a median follow-up of 30 months. Ductal drainage procedures effectively relieve the pain of chronic pancreatitis without further compromising pancreatic function.