Surgery in tropical pancreatitis.

Nineteen consecutive patients with tropical pancreatitis and chronic pancreatic pain operated upon over a 3-year period in Kerala, India, are reported. The pancreatic ductal morphology was studied by ultrasound scan, endoscopic retrograde cholangiopancreatography and/or operative pancreatography. In 17 patients, duct drainage by lateral pancreatojejunostomy and/or transduodenal pancreatic sphincteroplasty constituted the main surgical procedure. Caudal pancreatic resection was required in six of these patients. Unresectable pancreatic masses were found in two patients. Three patients died. Of the 16 survivors, 14 had good relief of pain within the limits of the available follow-up. In analysing the results, patients with 'obstructive pancreatitis' were found to have increased morbidity and mortality. The need to diagnose this subgroup of chronic pancreatitis pre-operatively is discussed.