Long-term results of pancreatojejunostomy in patients with chronic pancreatitis.

During a 10 year period, 69 patients with pancreatic duct dilation of 7 mm or more and intractable pain from chronic pancreatitis underwent Roux-Y drainage either as a lateral pancreatojejunostomy on 48 occasions or as a caudal pancreatojejunostomy in 21 cases. Nine patients (three with caudal pancreatojejunostomy and six with lateral pancreatojejunostomy) were lost to follow-up within the first postoperative year. The residual 60 patients undergoing 64 procedures were followed for an average of 69.3 months (range 10 to 144 months). Four patients with recurrent pain after caudal pancreatojejunostomy were converted to a lateral pancreatojejunostomy, with resolution of pain. Long-term pain relief occurred significantly more often in patients undergoing lateral pancreatojejunostomy than in those who received a caudal pancreatojejunostomy (66 versus 34 percent, p less than 0.01). Accordingly, caudal pancreatojejunostomy has little place in the surgical management of these patients. Since no differences existed in the two surgical populations, long-term pain relief in chronic pancreatitis appears more favorably influenced by the choice of an appropriate surgical procedure, rather than resulting solely from progressive destruction of the gland, as has been claimed. Although successful results in patients with lateral pancreatojejunostomy could not be correlated with anastomotic suture technique (one layer versus two layers or capsule versus mucosa-to-mucosa, p greater than 0.05), the creation of a pancreatojejunal anastomosis of more than 6 cm was found to be critical for success (p less than 0.001). Restoration of either exocrine or endocrine function should not be anticipated after otherwise successful lateral pancreatojejunostomy. However, if ductal dilatation can be demonstrated, recurrent pain after lateral pancreatojejunostomy is best managed by repeat lateral pancreatojejunostomy rather than resection.