Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis

Thomas Howard, Jeffrey S. Browne, Nicholas Zyromski, Harish Lavu, Marshall S. Baker, Changyu Shen, James A. Madura

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Resection and drainage operations achieve long-term pain relief in approximately 85% of patients with chronic pancreatitis (CP). In patients who develop recurrent pain, a few data exist on the long-term results of remedial operations. Over an 18-year period (1988-2006), 316 patients with CP had primary resection or drainage operations at our institution. Thirty-nine developed recurrent pain and were treated by a remedial resection or drainage operation. Patient demographics, time to symptom recurrence, radiographic anatomic abnormalities, type of remedial operation, postoperative morbidity, and long-term outcomes were analyzed. Thirty-nine patients, 56% female with a mean age of 41 years (range 16-61 years) had either remedial resection: total pancreatectomy (TP; N∈=∈8), pancreaticoduodenectomy (PD; N∈=∈6), distal pancreatectomy (DP; N∈=∈5), or drainage operation: duodenal preserving pancreatic head resection (DPPHR; N∈=∈8), revision of pancreaticojejunostomy (N∈=∈12). TP achieved pain relief in 88% with postoperative complications greater than or equal to grade III in 38% and diabetes in 100%. Drainage operations achieved pain relief in 67% of patients with postoperative complications greater than or equal to grade III in only 8%. Partial parenchymal resections (DPPHR, PD, DP) as a remedial procedure achieved pain relief <50% of the time. Drainage procedures, when anatomically feasible, are the preferred reoperation to treat patients with recurrent pain after failed primary operation for chronic pancreatitis.

Original languageEnglish
Pages (from-to)2087-2096
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number12
DOIs
StatePublished - Dec 2008

Fingerprint

Chronic Pancreatitis
Drainage
Pain
Pancreatectomy
Pancreaticojejunostomy
Pancreaticoduodenectomy
Reoperation
Demography
Morbidity
Recurrence

Keywords

  • Chronic pancreatitis
  • Distal pancreatectomy
  • Duodenal-preserving pancreatic head resection
  • Pancreaticoduodenectomy
  • Pancreaticojejunostomy
  • Remedial operation

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis. / Howard, Thomas; Browne, Jeffrey S.; Zyromski, Nicholas; Lavu, Harish; Baker, Marshall S.; Shen, Changyu; Madura, James A.

In: Journal of Gastrointestinal Surgery, Vol. 12, No. 12, 12.2008, p. 2087-2096.

Research output: Contribution to journalArticle

Howard, Thomas ; Browne, Jeffrey S. ; Zyromski, Nicholas ; Lavu, Harish ; Baker, Marshall S. ; Shen, Changyu ; Madura, James A. / Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis. In: Journal of Gastrointestinal Surgery. 2008 ; Vol. 12, No. 12. pp. 2087-2096.
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abstract = "Resection and drainage operations achieve long-term pain relief in approximately 85{\%} of patients with chronic pancreatitis (CP). In patients who develop recurrent pain, a few data exist on the long-term results of remedial operations. Over an 18-year period (1988-2006), 316 patients with CP had primary resection or drainage operations at our institution. Thirty-nine developed recurrent pain and were treated by a remedial resection or drainage operation. Patient demographics, time to symptom recurrence, radiographic anatomic abnormalities, type of remedial operation, postoperative morbidity, and long-term outcomes were analyzed. Thirty-nine patients, 56{\%} female with a mean age of 41 years (range 16-61 years) had either remedial resection: total pancreatectomy (TP; N∈=∈8), pancreaticoduodenectomy (PD; N∈=∈6), distal pancreatectomy (DP; N∈=∈5), or drainage operation: duodenal preserving pancreatic head resection (DPPHR; N∈=∈8), revision of pancreaticojejunostomy (N∈=∈12). TP achieved pain relief in 88{\%} with postoperative complications greater than or equal to grade III in 38{\%} and diabetes in 100{\%}. Drainage operations achieved pain relief in 67{\%} of patients with postoperative complications greater than or equal to grade III in only 8{\%}. Partial parenchymal resections (DPPHR, PD, DP) as a remedial procedure achieved pain relief <50{\%} of the time. Drainage procedures, when anatomically feasible, are the preferred reoperation to treat patients with recurrent pain after failed primary operation for chronic pancreatitis.",
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