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Ronald F. Martin, MD; Ricardo L. Rossi, MD; Kenneth A. Leslie, MD

Arch Surg. 1996;131(3):247-252.

Abstract
Objective
To assess the long-term outcome of patients following pylorus-preserving pancreatoduodenectomy (PPPD) for chronic pancreatitis.

Design
Retrospective study with mean follow-up of 63 months (range, 1 month to 13.7 years).

Setting
Tertiary referral hospital.

Patients
Records of all patients who underwent PPPD for chronic pancreatitis at Lahey Clinic were reviewed. All patients who were alive were contacted by telephone. In cases where patients had died, information was gathered from family members and hospital records.

Results
Forty-five patients underwent PPPD for disabling chronic pancreatitis. The mean preoperative duration of pain was 50 months, with 32 patients (70%) requiring daily narcotics. In one patient resection of the portal vein was required. One patient died within 30 days of the operation. Forty-one patients (92%) had improvement of pain at 5 years. The mean pain score (on a scale of 0 to 10) was 9.2 preoperatively and 1.5, 0.8, 1.1, and 1.1 at 6 months, 1 year, 2 years, and 5 years, respectively. Thirty-three patients (74%) had a postoperative weight gain to an average of 92% of their pre-illness weight. New-onset diabetes occurred in six patients (14%) by 6 months and in 21 patients (46%) by 5 years. Hypoglycemia was the cause of death in one patient who underwent total pancreatectomy. Four patients died of causes unrelated to PPPD. Marginal ulcers occurred in five patients (10%). Nine patients required late operations.

Conclusions
In selected patients, resection of the head of the pancreas achieves long-term pain improvement in over 90% of cases. The early development of diabetes mellitus is infrequent, but over longer follow-up periods it reaches prevalence rates similar to those described in patients who have not undergone resection. Weight gain in this group was superior to that previously reported for our patients who underwent "standard Whipple" operation for chronic pancreatitis.

(Arch Surg. 1996;131:247-252)

Author Affiliations
From the Lahey Clinic Medical Center, Burlington, Mass. Dr Martin is currently affiliated with the Division of General Surgery, Maine Medical Center and Mercy Hospital, Portland, and University of Vermont Medical School, Burlington. Dr Rossi is currently affiliated with the Department of General Surgery, Hospital Clinico and Pontificia Universidad Catolica de Chile, Santiago, Chile, and Harvard Medical School, Boston, Mass.

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