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Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

Methods

All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis.

Results

A total of 60 patients (age 51.6 years, 53 % males) were included in our study, of whom 42 (70 %) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62 %) patients with toxic etiology, 36 (60 %) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p < 0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95 % CI 1.3, 24.5, p = 0.02).

Conclusion

Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

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Funding

This study was supported by the Pancreatitis Research Fund at the Johns Hopkins Medical Institutions (VKS).

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Authors and Affiliations

  1. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Amitasha Sinha, Yuval A. Patel, Elham Afghani & Vikesh K. Singh

  2. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Michael Cruise & Karen Matsukuma

  3. Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Atif Zaheer

  4. Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Dhiraj Yadav

  5. Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Martin A. Makary & Kenzo Hirose

  6. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Dana K. Andersen

  7. Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Atif Zaheer, Martin A. Makary, Kenzo Hirose & Vikesh K. Singh

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  1. Amitasha Sinha
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  2. Yuval A. Patel
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Correspondence to Vikesh K. Singh.

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Sinha, A., Patel, Y.A., Cruise, M. et al. Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure. J Gastrointest Surg 20, 734–740 (2016). https://doi.org/10.1007/s11605-016-3081-7

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  • DOI: https://doi.org/10.1007/s11605-016-3081-7

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