Randomised trial of organ- vs. pylorus-preserving pancreatic head resection

Introduction: In chronic pancreatitis, enlargement of the head of the pancreas develops in consequence of inflammatory alterations. In a prospective, randomized, control trial organ-preserving pancreatic head resection (OPPHR) was compared with pylorus-preserving pancreatoduodenectomy (PPPHR) to assess the advantages and disadvantages of each type of operation.

Patients and Methods: Forty patients were allocated randomly to either the OPPHR (n=20) or the PPPHR (n=20) group. The interval between symptoms and surgery ranged from 5 to 12 years. The surgical data, postoperative complications, induction of diabetes mellitus, postoperative pain and quality of life one year postoperatively were considered. Results: The two study groups of 20 patients were well balanced with regard to sex, age, chronic pancreatitis history, and indication for surgery. The duration of the operation for OPPHR and PPPHR was 142.5±4.9min. and 278±6.9min., respectively (p<0.05). The postoperative mortality was zero. After OPPHR and PPPHR, the morbidity was zero and 10%, respectively. The duration of hospital stay was also significantly different: 8.05±0.9 days vs. 13.8±3.9 days (p<0.05). After one year the pain relief was effective in both groups, but 3 patients acquired diabetes mellitus following PPPHR. The body weight increased by 5.8±0.9kg and 3.2±0.3kg after OPPHR and PPPHR, respectively (p<0.05).

Conclusion: The two procedures are equally safe and effective with regard to pain relief but OPPHR is superior to PPPHR not only in the operation data and morbidity, but also in the quality of life one year postoperatively. OPPHR should be regarded as a recommended procedure in the treatment of chronic pancreatitis.