Changing trends in operations for chronic pancreatitis: a 22-year experience.

OBJECTIVE

To report the evolution of methods of surgical treatment of chronic pancreatitis.

DESIGN

Retrospective analysis.

SETTING

Private clinic, USA.

SUBJECTS: 448 consecutive patients who were operated on for chronic pancreatitis.

INTERVENTIONS: Resection (n = 286) or drainage of the duct (n = 162).

MAIN OUTCOME MEASURE: Changes over the 22-year period.

RESULTS

There was a change towards resection after 1985 (195/238, 59%, from 1976-90 compared with 91/120, 76%, from 1991-97), partly because of suspicions of malignancy. In recent years (1991-97) pylorus-preserving pancreaticoduodenectomy has come to be preferred over classic resection including antrectomy (22/36, 61%, compared with 11/69, 16%). Eight duodenum-preserving resections have been done since 1994.

CONCLUSIONS

More resections, particularly proximal pancreatectomies, are done nowadays. Lateral pancreaticojejunostomy has become the preferred drainage procedure, and pylorus-preserving pancreaticoduodenectomy is favoured over classic pancreaticoduodenectomy.