Surgical management of chronic pancreatitis with portal hypertension--a 19-year experience.

Background: The presence of portal hypertension in chronic pancreatitis imposes great challenges on the clinician. The objective of this retrospective analysis is to identify the demographics, presentation, management and outcomes among patients suffering from chronic pancreatitis with associated portal hypertension.

Patients: The data of fifty-seven patients (36 males, 21 females, age range 23 to 54 years; median 34.5) with chronic pancreatitis and portal hypertension who were operated either for intractable pain or complications over a 19-year period were analyzed. The etiology was alcohol abuse in 28 and idiopathic (tropical) in the remainder. The commonest presentation was abdominal pain in 52 patients (91%). Only 11 patients presented with gastrointestinal bleeding (19%), and they were managed by endoscopic therapy (sclerotherapy, banding, or ethoxysklerol injection). The surgical procedures were: 43 Frey procedures, 11 lateral pancreaticojejunostomies, and 3 Whipple's resections with additional procedures (cyst/biliary drainage or distal pancreatectomy) when appropriate. Direct operations for portal hypertension were required in only 19 patients (splenectomy (n = 15) and gastric devascularization (n = 4)).

Results: Operating times ranged from 210 to 490 minutes (median 320), yet only 11 patients required blood transfusion. There were 24 complications in 18 patients, and hospital stay ranged between 11 and 62 days (median 18.5). One patient died of liver failure on day 17 after operation. Forty-nine out of 53 patients available for follow-up had excellent or good pain relief.

Conclusion: Surgery provided good relief of pain and complications in patients with chronic pancreatitis and portal hypertension. Isolated surgery for portal hypertension alone was not required in any of the patients.