Duodenum- and spleen-preserving total pancreatectomy for end-stage chronic pancreatitis

Background: Total pancreatectomy may be warranted in patients with advanced chronic pancreatitis in whom partial resection has failed and in those with end-stage pancreatic function. A new operation, duodenum- and spleen-preserving total pancreatectomy, is described. Methods: Nineteen consecutive patients with chronic pancreatitis who had duodenum- and spleen-preserving total pancreatectomy were studied. Results: There were 15 men and four women with a median age of 40 (range 29-64) years. The aetiology was alcohol misuse in nine, hereditary pancreatitis in five and idiopathic in five patients. All patients had chronic intractable abdominal pain. Six had undergone pancreatic surgery previously and one had had multiple coeliac plexus blocks. There were ten postoperative complications in five patients, and one hospital death. The median hospital stay was 25 (range 10-84) days. There was a reduction in pain (P < 0.001) and analgesic use (P < 0.001) after surgery, and weight gain was noted at 12 and 24 months (P < 0.001). Nine patients required readmission to hospital, four because of surgical complications: adhesional obstruction in one, biliary stricture in two and duodenal obstruction in one. In the other five patients (four of whom had long-standing pre-existing diabetes mellitus) readmission was for better control of pain (three patients), diabetes mellitus (two), and diabetes-associated diarrhoea (two) or gastropathy (one). Conclusion: Duodenum- and spleen-preserving total pancreatectomy has a role in selected patients with medically intractable pain from chronic pancreatitis.