Parapancreatic biliary and intestinal obstruction in chronic obstructive pancreatitis. Is prophylactic bypass necessary?

Prophylactic bypass of the common duct and duodenum at the time of pancreatojejunostomy for chronic pancreatitis (triple bypass) has been recommended. If the subsequent development of parapancreatic obstruction were sufficiently frequent, such a recommendation would deserve more wide-spread application. In a group of 80 patients with otherwise uncomplicated chronic pancreatitis who underwent pancreatojejunostomy for control of pain, remote postoperative parapancreatic obstruction occurred in only 5 of 62 patients (8 percent) during an average follow-up of 6 years. Prophylactic bypass of the common duct and duodenum at the time of pancreatojejunostomy is not warranted. However, the overall 13.7 percent incidence of parapancreatic obstruction in patients undergoing operation for chronic pancreatitis is sufficiently high to remind the prudent surgeon that long-term postoperative evaluation of these patients is necessary.