Pain relief by surgery in chronic pancreatitis? Relationship between pain relief, pancreatic dysfunction, and alcohol withdrawal.

Since 1963, 57 consecutive patients with chronic pancreatitis, 44 of them alcoholics who had been operated upon for recurrent severe pain, have been controlled regularly for an average of 6 years. Thirty-two of them had a cyst drainage procedure (group A), and 25 had a ductal drainage procedure and/or distal pancreatectomy (group B). Ten patients died within 2 years (group A, n = 5). Lasting pain relief by surgery occurred in 19 patients only. Of 28 patients with pain relapses after surgery (group A, n = 15), however, 22 (78.6%) obtained late pain relief 1-8 years after surgery in association with marked increase of pancreatic dysfunction (group A, n = 12). Pain relief was associated with pancreatic calcifications in 71-86% of the alcoholics. Cyst drainage procedures were successful in preventing pain relapses mainly in patients with either advanced pancreatic dysfunction or in non-alcoholic pancreatitis. The data suggest that in chronic pancreatitis lasting pain relief is more often due to marked pancreatic dysfunction than to surgery. Alcohol abstinence after surgery was probably an additional factor for lasting pain relief in some patients.