Functional and Morphological Outcome of Patients Undergoing Surgery for Chronic Pancreatitis

Anil Mani, Dr, Vikas Gupta, Dr, Thakur D Yadav, Dr, Rakesh Kochhar, Dr, Naveen Kalra, Dr, Bikash Medhi, Dr. Post Graduate Institute Of Medical Education and Research, Chandigarh, India

INTRODUCTION: This study was conducted to evaluate the functional (exocrine, endocrine, pain relief and quality of life) and morphological outcome of patients undergoing surgery for chronic pancreatitis.

METHODS AND PROCEDURES: 39 patients underwent surgery (Frey n=27, others n=12). Preoperative assessment was done on admission. Exocrine function was evaluated using fecal fat globule estimation and endocrine function using HbA1c estimation. Quality of life was measured using EORTC-QLQ C30 questionnaire. Pain relief was measured on basis of need for analgesics and decrease in VAS score. Postoperatively patients were followed up at or after 3 months. MRI was done at follow up to evaluate the morphological outcome.

RESULTS: Exocrine insufficiency was detected in 76.92% of patients postoperatively (new onset – 41%). Endocrine insufficiency was detected in 33.3% (new onset – 23%). The mean BMI increased from 19.96 ± 3.11 to 20.98 ± 1.94 (p-value – 0.005). The mean weight gain was 3.10 ± 9.38 kg. The mean serum albumin level increased from 4.29 ± .067 to 4.6 ± .067 (p-value – 0.041). The pain relief was 89.74 %. Quality of life improved from 30.77 ± 21.47 to 69.23 ± 21.13 (p-value – <0.001). The mean MPD diameter decreased from 7.7 ± 2.66 to 3.44 ± 1.44 mm (p-value <0.001). There was no correlation of parenchymal thickness and duct to parenchyma ratio with exocrine insufficiency.

CONCLUSIONS: Surgical treatment offers good pain relief, substantial improvement in quality of life and remarkable nutritional status improvement in chronic pancreatitis even at the cost of some amount of exocrine and endocrine function deterioration.