Pyloric-Preserving Pancreatectomy for Chronic Pancreatitis
The operative treatment of chronic pancreatitis has proved to be far less than perfect. Within the past decade we have learned that procedures on the ampulla of Vater or sphincter of Wirsung’s duct very seldom give pain relief . Distal pancreatectomy when followed for up to 5 years shows a disappointing decline in the percentage of adequate results after the first 1–2 years . Total pancreatectomy in earlier years at the Lahey Clinic was followed by a very high late morbidity and mortality ; since the time of this report, we have learned to select patients with greater care and now advise this procedure only for patients who have relatively stable life-styles and are self-disciplined. Puestow’s procedure, or pancreatojejunostomy, is useful for patients with pancreatic ducts dilated more than 7 mm in diameter. But even these patients have an approximately 20% rate of failure at 2–4 years .
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