ROLE OF VARIOUS SURGICAL INTERVENTIONS IN CHRONIC PANCREATITIS.

Abstract

BACKGROUND - Chronic pancreatitis is a progressive inammatory disease characterised by irreversible destruction of pancreatic tissue. An acute attack of pancreatitis is characterised by severe pain in abdomen which in later stages leads to exocrine and endocrine pancreatic insufciency. Patients with chronic pancreatitis suffer from a decreased quality of life due to chronic abdominal pain and often require hospital admission for alleviating the symptoms. The only indication for surgery in such cases is pain and sometimes pancreatic insufciency. METHODS AND MATERIAL - A prospective observational study on role of various surgical interventions in chronic pancreatitis was conducted at Department of General Surgery, Grant Government Medical College, Sir J.J Group of Hospitals, Mumbai.64 patients of chronic pancreatitis were enrolled into the prospective observational study and followed up over a period of 15 months. Results – Out of 64 patients, 32 (50%) were treated conservatively, 15 (23.4%) underwent endoscopy and 17 (26.6%) underwent some surgical intervention. Mean post operative pain score by visual analogue scale in the participants of the surgical intervention group was 4.82 while the endoscopy group was 5.86. Conclusion - The treatment of pain in Chronic Pancreatitis is a step-up approach i.e., conservative management, endoscopic therapy then surgical intervention. Early surgical intervention, compared to the current step-up approach, may be better in terms of pain control and pancreatic function. Total patients with initial endoscopic or conservative medical treatment undergoing surgical intervention at later stages were found to have better outcome. It was seen that surgery is superior to endoscopy for pain control in patients with chronic pancreatitis. The complication rate and readmission were also less after surgical intervention than endoscopic intervention. Interventional radiological techniques play an important role in patient management for chronic pancreatitis who defer from surgery.