Long-Term Follow-Up after Pylorus-Preserving Pancreatoduodenectomy for Severe Complications of Chronic Pancreatitis

Aim: Severe or potentially fatal complications of chronic pancreatitis occur more commonly in the head of the pancreas. We wished to outline the selection criteria for resection and then provide long-term results after pylorus preserving pancreatoduodenectomy. Methods: Between 1986 and 1995, 44 patients underwent pancreatoduodenectomy for the following categories of complicated chronic pancreatitis in the pancreatic head – expanding pseudocyst, multiple pseudocysts, pancreatic and bile duct obstruction, or pancreatic duct obstruction alone. These pathological changes were always associated with incapacitating pain and all patients were taking narcotic analgesics. Long-term follow up was completed in 97% of patients that were over 1 year postoperative (n = 35) with an average follow-up time of 46 months (1-9.3 years). Results: Operative mortality was zero. Actual 5-year survival was 88%. Deaths were due to unrelated causes. All patients were relieved of severe abdominal pain while 86% were completely pain free. The remainder had mild left-sided pain from remnant pancreatitis usually associated with a return to alcohol use. Oral analgesics were being used in 9%. Average weight ranged from 102 to 106% of the operative weight between 1 and 5 years postoperative. Diarrhea was prominent in 14% and was due to inadequate exocrine enzyme replacement. Diabetes was present preoperatively in 43% and postoperatively in 54%. By analyzing cases at risk to develop diabetes we found the few new cases of diabetes were due to persistent fibrosis in the pancreatic remnant and not due to operation. Conclusions: When properly selected based on pathologic criteria, the patient suffering from severe complications of chronic pancreatitis in the head of the gland will benefit from pylorus-preserving pancreatoduodenectomy. Long-term pain control will be achieved with little gastrointestinal sequelae.