The Whipple procedure for severe complications of chronic pancreatitis

Abstract

Objective: To analyze the clinical indications and long-term results for the Whipple procedure used for severe complications of chronic pancreatitis (CP).

Design: A series of 28 patients requiring the Whipple procedure for CP were reviewed by one surgeon between 1986 and 1993.

Setting: A multispecialty group practice hepatobiliary pancreatic referral center.

Patients: The referred patients with CP complications in the pancreatic head were anatomically defined by endoscopic retrograde cholangiopancreatographic and computed tomographic scans to include expanding pseudocysts, pancreatic duct disruption, arteriovenous fistula, or calcified obstructive fibrosis of bile duct, pancreatic duct, and/or duodenum.

Intervention: The Whipple procedure (pylorus-preserving [n = 25] or standard [n = 3]) was performed after preoperative assessment with a mesenteric arteriogram and, as necessary, percutaneous drainage or endoscopic stenting of pseudocyst, pancreatic duct, or bile duct were performed.

Main outcome measures: Mortality, morbidity, length of hospital stay, and long-term results of the operation.

Results: There was no mortality. A 36% morbidity rate included adult respiratory distress syndrome (n = 3) secondary to a long operation time (average, 9.8 hours) or infected tissue and delayed gastric function (> 14 days) secondary to retrogastric amylase-rich fluid collections (n = 4). Long-term follow-up in 25 patients after 27 months (range, 3 to 84 months) showed that 88% were pain-free and 12% had improved. None had recurrent pancreas problems, but 28% had resumed drinking alcohol. Inability to gain weight was noted in 4% and a marginal ulcer in 4%.

Conclusions: The Whipple procedure for severe complications of CP in the pancreatic head is a safe and effective operation leaving little gastrointestinal sequelae. Preoperative endoscopic and radiological assessment, drainage, and stenting procedures are key elements to achieving positive results.