Appraisal of operative treatment for chronic pancreatitis. With special reference to side to side pancreaticojejunostomy.

A total of sixty-one operations were performed in sixty of seventy-one patients with chronic pancreatitis, with the following results. 1. The procedures used were side to side pancreaticojejunostomy in twenty-four patients, caudal pancreatectomy in ten, pancreaticoduodenectomy in six, total pancreatectomy in one, removal of pancreatic calculi in four, cystojejunostomy in two, biliary tract procedures in twelve, and drainage of pancreatic abscess in one. Operative fatality occurred in six patients, with fifty-four surviving operation. 2. Of fifty-three patients surviving operation (excluding the one who underwent only exploratory laparotomy), forty-seven (88 per cent) had relief of pain. With the exception of two patients with complicating cancer of the pancreas at the time of operation, of fifty-two patients surviving operation, thirty-nine (75 per cent) had satisfactory results at follow-up study. 3. Sixteen of twenty-four patients (66.7 per cent) undergoing side to side pancreaticojejunostomy had satisfactory follow-up results. 4. Comparison of pre- and postoperative body weight levels in twenty-one patients undergoing side to side pancreaticojejunostomy showed a postoperative loss of less than 10 per cent in seven, unchanged weight in two, and a gain in eleven patients, including five with more than 10 per cent gain. However, fat absorption examination in these patients showed no distinct postoperative improvement in digestion and absorption. 5. Histologic evidence in one patient at autopsy four years and eleven months after side to side pancreaticojejunostomy indicated improvement in fibrosis of the pancreas as compared with the findings at operation.