Duodenum-Preserving Total Pancreatectomy for Chronic Pancreatitis

Abstract

The role of surgery in the management of chronic pancreatitis is a subject of debate [1]. Most would agree that the place for surgery is clear when there is a complication of chronic pancreatitis which is amenable to surgical intervention. Unfortunately, the problem often facing the clinician is that of a patient with chronic pain, on an increasing dose and strength of analgesia, and whose quality of life is destroyed by the effects of both pain and analgesia. There is a group of patients who fail to respond to, or who relapse after, non-surgical procedures such as nerve blocks and endoscopic sphincterotomies; of these there are some whose symptoms are not relieved by pancreatic drainage procedures or partial pancreatectomies. In the patient with intractable pancreatic pain the lesser operative procedures have usually been tried but have failed. This type of patient is usually on high doses of a narcotic analgesic, but still incapacitated by unremitting pain; for such patients there is little to offer other than total pancreatectomy.