Abstract
Chronic pancreatitis was a recognized clinical entity in the British Isles at the beginning of the twentieth century, but until little more than 30 years ago, it was considered to be a rare condition and received scant attention from British surgeons. During the second half of the twentieth century, the incidence of the disease in the British Isles has increased significantly and alcohol abuse has become, by far, the most important etiological factor. Per capita consumption of alcohol in the British Isles has increased very markedly in the past 30 years and alcohol abuse is becoming a major social problem, but, although chronic pancreatitis is more common now than it was 30 years ago, the increase in its incidence is a good deal less than might be expected. British surgeons are agreed that intractable pain is the cardinal indication for surgical intervention in chronic pancreatitis and success depends on selection of the operative procedure most appropriate to the pathological state of the pancreas and, in particular, of its ductal system. In recent years, British surgeons in highly specialized units have become more radical in their approach to the treatment of chronic pancreatitis with total pancreatectomy in selected patients currently being advised more frequently than in previous decades.
Résumé
On a reconnu la pancréatite chronique comme entité clinique dans les Iles Britanniques dès le début du XXe siècle mais 30 ans en arrière on la considérait encore comme rare et elle n'avait pas attiré l'attention des chirurgiens britanniques. Au cours de la 2e moitié du XXe siècle, l'incidence de las pancréatite chronique aux Iles Britanniques a augmenté de façon significative; l'alcoolisme en est la cause la plus répandue. La consommation d'alcool a considérablement augmenté depuis 30 ans et l'alcoolisme devient un problème social inquiétant. Pourtant, même si la pancréatite chronique est plus fréquente qu'il y a 30 ans, on aurait pu s'attendre à pire. Les chirurgiens britanniques s'accordent pour dire que l'indication chirurgicale principale de pancréatite chronique est la douleur invétérée. Le succès dépend de la sélection du procédé le mieux adapté à l'état pathologique du pancréas et en particulier du système canalaire. Ces dernières années, les chirurgiens britanniques dans les unités spécialisées ont adopté une attitude plus radicale dans le traitement de la pancréatite chronique; on a vu ainsi augmenter, dans les cas bien sélectionnés, la fréquence de la pancréatectomie totale.
Resumen
La pancreatitis crónica ha sido una entidad clínica reconocida en las Islas Británicas desde los comienzos del siglo veinte, pero hasta hace un poco más de 30 años era considerada como una enfermedad rara a la cual poca atención prestaban los cirujanos británicos. En el curso de la segunda mitad del siglo veinte la incidencia de esta enfermedad ha aumentado en las Islas Británicas en forma significativa y el abuso del alcohol ha venido a convertirse en el factor etiológico de mayor importancia. El consumo per capita de alcohol ha aumentado en las Islas Británicas marcadamente en los últimos 30 años y el abuso del alcohol representa un problema social mayor; sin embargo, aunque la pancreatitis crónica es actualmente más frecuente que hace 30 años, el incremento en su incidencia es considerablemente menor de lo que podría esperarse. Los cirujanos británicos están de acuerdo en que el dolor es la indicación principal para la intervention quinirgica en la pancratitis crónica y que el éxito depende de la selección del procedimiento operatorio según el estado del páncreas y en particular de su sistema ductal. En los años más recientes los cirujanos británicos, en instituciones altamente especializadas, han venido a ser más radicales en cuanto al tratamiento de la pancreatitis crónica y la pancreatectomía total, para pacientes seleccionados, es recomendada con mayor frecuencia que hace unos anos.
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MacLaren, I.F. Observations and surgical management of chronic pancreatitis in the British Isles: A review of the twentieth century. World J. Surg. 14, 19–27 (1990). https://doi.org/10.1007/BF01670540
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DOI: https://doi.org/10.1007/BF01670540