This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Duodenum‐ and spleen‐preserving total pancreatectomy for end‐stage chronic pancreatitis. BJS 2003; 90: 1401-1408.
Published: 28th October 2003
Authors: N. Alexakis, P. Ghaneh, S. Connor, M. Raraty, R. Sutton, J. P. Neoptolemos et al.
Background
Total pancreatectomy may be warranted in patients with advanced chronic pancreatitis in whom partial resection has failed and in those with end‐stage pancreatic function. A new operation, duodenum‐ and spleen‐preserving total pancreatectomy, is described.
Method
Nineteen consecutive patients with chronic pancreatitis who had duodenum‐ and spleen‐preserving total pancreatectomy were studied.
Results
There were 15 men and four women with a median age of 40 (range 29–64) years. The aetiology was alcohol misuse in nine, hereditary pancreatitis in five and idiopathic in five patients. All patients had chronic intractable abdominal pain. Six had undergone pancreatic surgery previously and one had had multiple coeliac plexus blocks. There were ten postoperative complications in five patients, and one hospital death. The median hospital stay was 25 (range 10–84) days. There was a reduction in pain (P < 0·001) and analgesic use (P < 0·001) after surgery, and weight gain was noted at 12 and 24 months (P < 0·001). Nine patients required readmission to hospital, four because of surgical complications: adhesional obstruction in one, biliary stricture in two and duodenal obstruction in one. In the other five patients (four of whom had long‐standing pre‐existing diabetes mellitus) readmission was for better control of pain (three patients), diabetes mellitus (two), and diabetes‐associated diarrhoea (two) or gastropathy (one).
Conclusion
Duodenum‐ and spleen‐preserving total pancreatectomy has a role in selected patients with medically intractable pain from chronic pancreatitis. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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