Duodenum-preserving total pancreatectomy for end stage chronic pancreatitis

✍ Scribed by M. A. Lambert; I. P. Linehan; Mr. R. C. G. Russell

• Publisher: John Wiley and Sons
• Year: 1987
• Tongue: English
• Weight: 581 KB
• Volume: 74
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800740112

✦ Synopsis

Abstract
The classical Whipple procedure for chronic pancreatitis has been associated with significant long term postoperative morbidity. The pylorus-preserving procedure of Longmire has reduced but not eliminated the long-term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of patients with end-stage chronic pancreatitis after favourable experience with this procedure in infants for nesidioblastosis. Fourteen patients with chronic pancreatitis have had a total pancreatectomy with preservation of the duodenum and the bile duct. All patients are still alive (median follow-up 9·5 months) and none suffered major complications in the perioperative period. One patient developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the patients have returned to full-time work; nine require no analgesia. All patients require pancreatic enzyme replacement, and all patients have gained weight postoperatively. Diabetic control is satisfactory with a twice daily insulin regime. Duodenum-preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of the diabetes.