The natural history of chronic pancreatitis after operative intervention: The need for revisional operation

Vikrom K. Dhar, Nick C. Levinsky, Brent T. Xia, Daniel E. Abbott, Gregory C. Wilson, Jeffrey J. Sussman, Milton T. Smith, Sampath Poreddy, Kyuran Choe, Dennis J. Hanseman, Michael J. Edwards, Syed A. Ahmad

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background For patients with chronic pancreatitis, duodenum-sparing head resections and pancreaticoduodenectomy are effective operations to relieve abdominal pain. For patients who develop recurrent symptoms after their index operation, the long-term management remains controversial. Methods Between 2002 and 2014, patients undergoing operative intervention for chronic pancreatitis were identified retrospectively. Patients requiring reoperation after their index operation were reviewed. Results A total of 121 patients with chronic pancreatitis underwent an index operation. At a median time of 33 months, 85 patients underwent no further operative intervention, while 36 patients underwent reoperation. A reoperative procedure was completed with acceptable perioperative morbidity and blood loss. After a revision operation, 25% of patients became narcotic independent. Narcotic requirements decreased from 143 morphine equivalent milligrams per day (MEQ/d) to 80 MEQ/d, and 58% of patients required less than 50 MEQ/d. Insulin requirements were not increased from preoperative levels. Multivariate analysis demonstrated only narcotic requirement and exocrine insufficiency after the index operation to be predictive for the need for a revision operation. Conclusion Our data demonstrate the following: (1) A significant number of patients undergoing duodenum-sparing head resections (26%) or pancreaticoduodenectomy (29%) required reoperation for recurrent abdominal pain; and (2) a revisional operation can be effective in relieving recurrent abdominal symptoms. Patients with recurrent symptoms should be considered for additional operative intervention.

Original languageEnglish (US)
Pages (from-to)977-986
Number of pages10
JournalSurgery
Volume160
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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