The Whipple procedure for severe complications of chronic pancreatitis
L. W. Traverso and R. A. Kozarek
Department of General Surgery, Virginia Mason Medical Center, Seattle, Wash.
OBJECTIVE: To analyze the clinical indications and long-term results for
the Whipple procedure used for severe complications of chronic pancreatitis
(CP). DESIGN: A series of 28 patients requiring the Whipple procedure for
CP were reviewed by one surgeon between 1986 and 1993. SETTING: A
multispecialty group practice hepatobiliary pancreatic referral center.
PATIENTS: The referred patients with CP complications in the pancreatic
head were anatomically defined by endoscopic retrograde
cholangiopancreatographic and computed tomographic scans to include
expanding pseudocysts, pancreatic duct disruption, arteriovenous fistula,
or calcified obstructive fibrosis of bile duct, pancreatic duct, and/or
duodenum. INTERVENTION: The Whipple procedure (pylorus-preserving [n = 25]
or standard [n = 3]) was performed after preoperative assessment with a
mesenteric arteriogram and, as necessary, percutaneous drainage or
endoscopic stenting of pseudocyst, pancreatic duct, or bile duct were
performed. MAIN OUTCOME MEASURES: Mortality, morbidity, length of hospital
stay, and long-term results of the operation. RESULTS: There was no
mortality. A 36% morbidity rate included adult respiratory distress
syndrome (n = 3) secondary to a long operation time (average, 9.8 hours) or
infected tissue and delayed gastric function (> 14 days) secondary to
retrogastric amylase-rich fluid collections (n = 4). Long-term follow-up in
25 patients after 27 months (range, 3 to 84 months) showed that 88% were
pain-free and 12% had improved. None had recurrent pancreas problems, but
28% had resumed drinking alcohol. Inability to gain weight was noted in 4%
and a marginal ulcer in 4%. CONCLUSIONS: The Whipple procedure for severe
complications of CP in the pancreatic head is a safe and effective
operation leaving little gastrointestinal sequelae. Preoperative endoscopic
and radiological assessment, drainage, and stenting procedures are key
elements to achieving positive results.
