Surgical treatment of chronic pancreatitis. A review after a ten-year experience.

Seventy-five operative procedures were done in 63 patients to correct one or more complications of chronic pancreatitis. Operations included resection, pancreaticojejunostomy, choledochoduodenostomy, draining and/or excision of pseudocysts, sphincteroplasty, and bypass surgery for relief of duodenal obstruction. All patients were followed up for up to 10 years, with 22 being followed up longer than five years. Recurrent pancreatitis occurred in three patients after resection and in two after drainage procedures, but attacks were milder with only an occasional occurrence. Operative procedures to relieve specific complications of chronic pancreatitis provided good results. However, because internal drainage of pseudocysts associated with chronic pancreatitis was frequently accompanied by recurrence of symptoms, excision offered better results. When the pancreatic duct was dilated, good results were obtained by pancreaticojejunostomy. In the absence of dilation, after strict preoperative slection of patients, and in the presence of diffuse parenchymal fibrosis, subtotal pancreatectomy is the procedure of choice.