The duodenum-preserving pancreatic head resection for chronic pancreatitis

A subgroup of patients with chronic pancreatitis develop inflammatory enlargement of the head of the pancreas. This may lead to a variety of complications on pancreatic neighboring organs often necessitating pancreatic surgery. The duodenum-preserving pancreatic head resection was developed to treat pancreatic head related complications in chronic pancreatitis without resection of the stomach or the duodenum. Operation indications are compression or stenosis of the common bile duct, the duodenum, the main pancreatic duct, and the retropancreatic vessels. In addition, recurrent abdominal pain which does not respond to medical treatment is an indication to perform a duodenum-preserving pancreatic head resection. The major advantage of this operation is the maintenance of the stomach and the duodenum and thereby of the physiological food passage. This is achieved by subtotal resection of the pancreatic head preserving a small pancreatic head remnant along the duodenal wall. Between 1972 and 1993, 298 patients with chronic pancreatitis underwent a duodenum-preserving pancreatic head resection. The indications to operate were pancreatic head enlargement (83%), main pancreatic duct obstruction, common bile duct obstruction (48%), duodenal obstruction (32%) and vascular obstruction (17%). 279 patients (94%) suffered from moderate to severe abdominal pain. Hospital mortality was 1.01% (3/298) and the rate of relaparotomy was 5.7%. Pancreatic fistula, intraabdominal abscess, bleeding, and leakage of the anastomosis occurred in 2.7, 3.0, 5.7 and 2.0%, respectively. In 1994 a long term follow-up was carried out (median follow up: 6.0 years). Late mortality was 9%. 88% of the patients had no or infrequent episodes of pain, and 63% were rehabilitated professionally. From our experience we conclude that the duodenum-preserving pancreatic head resection is an organ-preserving operation in patients with chronic pancreatitis and pancreatic head related complications. It provides excellent short- and long-term results and therefore it should be considered as a new standard operation in the surgical treatment of chronic pancreatitis.