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The Whipple partial duodenopancreatectomy for the treatment of chronic pancreatitis.

BACKGROUND/AIMS
Operations for chronic pancreatitis can be divided into drainage and resection procedures. The standard Whipple pancreatoduodenectomy is the preferred resection procedure for most cases of painful complicated pancreatitis centred in the pancreatic head.


METHODOLOGY
The medical records of 134 patients who underwent standard Whipple pancreatoduodenectomy for complicated chronic pancreatitis were analyzed. Exocrine and endocrine pancreatic function was assessed. Pain intensity was estimated using a pain scoring system. Mean follow-up was 8.3 years and the follow-up rate was 62%.


RESULTS
All patients underwent a standard Whipple pancreatoduodenectomy. Operative mortality was 0.7%. No postoperative complications were seen in 112 patients (83.6%). Re-laparotomy for adhesions, major septic complications, bleeding and pancreatic anastomotic leak were noted in 13 patients (9.7%). Delayed gastric emptying occurred in 1 patient (0.7%). Complete pain relief was noted in 66%. An increase in body weight was observed in 65% and 60% of the patients were able to return to work postoperatively. Postoperative exocrine insufficiency developed in 24% and postoperative diabetes in 12%.


CONCLUSIONS
The Whipple standard procedure proves to be a safe and effective technique for the treatment of chronic pancreatitis. More important than any particular operative technique is the selection of an appropriate method of management for each individual patient.