[Postoperative follow-up in patients with partial Whipple duodenopancreatectomy for chronic pancreatitis]

Abstract

Background and aim: Physicians and surgeons essentially agree today that chronic pancreatitis must primarily be treated conservatively. The aim of surgery in chronic pancreatitis is the treatment of symptoms. Surgical treatment cannot be a causal therapy for chronic pancreatitis. If surgery is indicated at all. Whipple's operation is considered to be the gold standard.

Patients and methods: Between 1973 and 1992, out of a total of 700 patients referred to the surgery University Department in Mannheim with the express purpose of having an operation for chronic pancreatitis, duodenopancreatectomy (Whipple's operation) was performed in 110 cases. 58 of these patients were followed up postoperatively and the results have been compared with preoperative findings.

Results: All patients returned to full or only slightly impaired activity. 60% took up work again, 40% retired after the operation with a mean age of 49 years. 38 patients (66%) were totally free of pain, 13 patients (22%) had less pain than preoperatively and only seven (12%) often need analgesics postoperatively because of abdominal pain. Preoperatively there has been a history of long-standing excessive alcohol use in 32 (55%) patients, in the postoperative period there was a significant reduction to only three (5%) patients. 40 patients clinically examined were in a sufficient nutritional condition. Exocrine function of the pancreas (stool chymotrypsin and fluorescein dilaurate test) showed an insufficiency in 20 (71%) of 28 cases. The preoperative exocrine function of the pancreas was not examined in most cases. Examination of endocrine function showed diabetes mellitus treated with insulin occurring preoperatively in six (10%) patients and in 21 (36%) patients postoperatively.

Conclusion: As chronic pancreatitis very often is concentrated in the head of the pancreas, Whipple's operation seems to be a good procedure for pain relief and concerning late results of life quality and socioeconomic situation.