Duodenum-preserving total pancreatic head resection for chronic pancreatitis: a report of 35eases / 中华普通外科杂志

ABSTRACT

Objective To evaluate a duodenum-preserving total pancreatic head resection procedure for the treatment of chronic panereatitis in patients with a pain-inducing enlarged pancreatic head. Methods From January 1999 to December 2006, 35 cases underwent duodenum-preserving total pancreatic head resection procedure without segment resection of the duodenum, as a modified Beger's procedure. Pain scale in the EORTC QLQ-C30 questionnaire was used to estimate the effect of the surgical procedure on pain relief, and oral glucose tolerance test (OGTF) was used to estimate the maintenance of endocrine function. Results For the anastomosis of the distal pancreas and the jejunum, end-to-end invagination anastomosis was performed in 21 cases, end-to-side duct to mucosa anastomosis was performed in 10 cases, and side-to-side duct drainage procedure was performed in 4 cases. Additional T-tube drainage of the common bile duct was adopted in 4 cases for a possible injury of the common bile duct, and anastomosis of the common bile duct and the duodenum was performed in 1 case for common bile duct obstruction. The mean operation time was 286±55 min, and the mean red blood cell (RBC) transfusion was 1.4±1.3 units. The mean hospital stay was 13±4 days. The mortality of the surgical procedure was 0. The overall morbidity was 17%. Pancreatic fistula developed in 1 case, bile leakage in 3 cases, wound disruption in 1 case, intraabdominal bleeding in 1 case, and there was no duodenal fistula. After the surgery, the mean EORTC QLQ-C30 pain scale decreased from 59±27 to 13±21. On follow-up the endocrine function remained stable, and no new case of diabetes was found. Conclusion The duodenum-preserving total pancreatic head resection procedure without segment resection of the duodenum has good postoperative outcomes, and benefits extirpation of inflammatory pancreatic lesions of the head and uncinate process. It is a safe and effective surgical procedure for chronic pancreatitis with an enlarged and painful pancreatic head.