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Changing trends in operations for chronic pancreatitis: a 22-year experience.

OBJECTIVE
To report the evolution of methods of surgical treatment of chronic pancreatitis.


DESIGN
Retrospective analysis.


SETTING
Private clinic, USA.


SUBJECTS
448 consecutive patients who were operated on for chronic pancreatitis.


INTERVENTIONS
Resection (n = 286) or drainage of the duct (n = 162).


MAIN OUTCOME MEASURE
Changes over the 22-year period.


RESULTS
There was a change towards resection after 1985 (195/238, 59%, from 1976-90 compared with 91/120, 76%, from 1991-97), partly because of suspicions of malignancy. In recent years (1991-97) pylorus-preserving pancreaticoduodenectomy has come to be preferred over classic resection including antrectomy (22/36, 61%, compared with 11/69, 16%). Eight duodenum-preserving resections have been done since 1994.


CONCLUSIONS
More resections, particularly proximal pancreatectomies, are done nowadays. Lateral pancreaticojejunostomy has become the preferred drainage procedure, and pylorus-preserving pancreaticoduodenectomy is favoured over classic pancreaticoduodenectomy.