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Operative Management of Chronic Pancreatitis in Children
Thomas R. Weber, MD;
Martin S. Keller, MD
Arch Surg. 2001;136:550-554.
Hypothesis Chronic pancreatitis in childhood is a rare but potentially debilitating disorder, and failure of conservative therapy with chronic pain medication use is common. We hypothesize that aggressive surgical therapy may hold promise for long-term remission.
Design Retrospective analysis of data collected prospectively for 12 years.
Setting Tertiary care children's hospital.
Patients Eighteen children (aged 3-13 years, 11 girls) underwent surgical treatment of chronic pancreatitis after 1 to 6 years of various medical therapies (parenteral nutrition, somatostatin, or pain medication). These patients required a mean ± SD 6 ± 0 hospitalizations before operation. Pancreatitis was familial in 9 patients, idiopathic in 5, and secondary to trauma and medication use in 2 each. Preoperative endoscopic retrograde cholangiopancreatography showed pancreatic duct dilatation in 7, strictures in 5, ductal stones in 4, and normal findings in 2. The operative therapy consisted of longitudinal pancreaticojejunostomy in 2 children (both children failed pancreaticojejunostomy but improved after undergoing pancreatectomy) and distal pancreatectomy with Roux-en-Y pancreaticojejunostomy in 16 children.
Outcome Measures Survival, need for rehospitalization or reoperation, and chronic pain medication requirements.
Results All patients survived. Follow-up ranged from 1 to 15 years. Thirteen (72%) of 18 patients have required no further hospitalizations or medications. Two patients required a second operation to convert their longitudinal pancreaticojejunostomy to distal pancreatectomy, and 3 patients have required 2 to 5 additional hospitalizations for recurrent pancreatitis. Endoscopic retrograde cholangiopancreatography on 5 patients 2 to 4 years postoperatively showed patent distal pancreaticojejunostomy.
Conclusions This series suggests that distal pancreatectomy and pancreaticojejunostomy are effective treatments for this difficult group of patients, while longitudinal pancreaticojejunostomy was ineffective. Long-term relief of pain and reduced need for rehospitalization are the usual results after this procedure.
From the Division of Pediatric Surgery, Department of Surgery, Cardinal Glennon Children's Hospital, St Louis University Health Sciences Center, St Louis, Mo.
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