Outcome after lateral pancreaticojejunostomy in patients with chronic pancreatitis associated with pancreas divisum.

In order to evaluate surgical outcome after lateral pancreaticojejunostomy (LPJ) in patients with pancreas divisum (PD), we compared the operative results in patients who underwent LPJ for PD with those who underwent LPJ for other causes of chronic pancreatitis. The records of 129 patients who underwent LPJ for chronic pain associated with chronic pancreatitis from 1995 through 2001 were retrospectively reviewed and analyzed. There were 21 patients (11 men, 10 women, mean age 40 years) who had PD as a cause of chronic pancreatitis. The remaining 108 patients (58 men, 50 women, mean age 48 years) had chronic pancreatitis of other etiologies. The two groups had a similar stage of disease progress measured by incidence of pancreatic duct strictures, terminal biliary stenosis, pseudocysts, insulin dependency, need for pancreatic enzymes, and symptom duration. There was no difference in operative time (200 +/- 13.3 vs. 206 +/- 6.1 minutes) or intraoperative blood loss (200 vs. 300 mL) comparing the PD to the other group. The overall postoperative morbidity (14% vs. 23%) and mortality (0% vs. 2%) were not significantly different in PD versus other group comparison. Hospital length of stay was similar in both groups (7.0 +/- 2.4 vs. 8.0 +/- 1.3 days). In the PD group 10 per cent required reoperation with pancreatic resection for failure of LPJ to improve chronic pain versus 9 per cent in the other group. Comparison of patients who undergo LPJ for PD with those who undergo LPJ for other etiologies showed no significant difference in failure rates as measured by the need for reoperation. Postoperative morbidity and mortality were similar in both groups. Failure of LPJ in patients with PD may be related to factors associated with failure of LPJ in management of chronic pancreatitis of other causes. This includes inadequate drainage of the head of gland, failure to drain small ducts, and perineural inflammation.