Ann Hepatobiliary Pancreat Surg.  2020 May;24(2):162-167. 10.14701/ahbps.2020.24.2.162.

Assessment of functional outcome of patients undergoing surgery for chronic pancreatitis: A prospective study

Affiliations
  • 1Departments of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India
  • 2Departments of Endocrinology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India

Abstract

Backgrounds/Aims
This study was done with the aim of assessing impact of surgery for chronic pancreatitis on exocrine and endocrine functions, quality of life and pain relief of patients.
Methods
35 patients of chronic pancreatitis who underwent surgery were included. Exocrine function assessed with fecal fat globule estimation and endocrine function assessed with glycated haemoglobin (HbA1C), fasting plasma glucose (FPG), Insulin and C-peptide levels. Percentage (%) beta cell function by homeostatic model assessment (HOMA) was determined using web-based calculator. Quality of life (QOL) and pain assessment was done using Short form survey (SF-36) questionnaire and Izbicki scores respectively. Follow up done till 3 months following surgery.
Results
Endocrine insufficiency was noted in 13 (37%) patients in the postoperative period compared to 17 (49%) patients preoperatively (p=0.74). Exocrine insufficiency was detected in 11 (32%) patients postoperatively compared to 8 (23%) patients preoperatively, with denovo insufficiency noted in 3 (8%) patients (p<0.05). The mean Izbicki score at 3 months postoperatively was remarkably lower compared to preoperative score (29.3±14.3 vs. 60.6±12.06; p<0.05). QOL at 3 months following surgery for chronic pancreatitis was significantly better than preoperative QOL (50.24±22.16 vs. 69.48±20.81; p<0.05).
Conclusions
Significant pain relief and improvement in quality of life among patients of chronic pancreatitis following surgery. However, worsening of exocrine function with only clinical improvement of endocrine function was also noted.

Keyword

Chronic pancreatitis surgery; Exocrine function; Endocrine function; Pain relief; Quality of life

Reference

1. Ammann RW, Heitz PU, Klöppel G. 1996; Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology. 111:224–231. DOI: 10.1053/gast.1996.v111.pm8698203. PMID: 8698203.
Article
2. Ebbehøj N, Svendsen LB, Madsen P. 1984; Pancreatic tissue pressure: techniques and pathophysiological aspects. Scand J Gastroenterol. 19:1066–1068. PMID: 6533777.
3. Bockman DE, Buchler M, Malfertheiner P, Beger HG. 1988; Analysis of nerves in chronic pancreatitis. Gastroenterology. 94:1459–1469. DOI: 10.1016/0016-5085(88)90687-7. PMID: 3360267.
Article
4. Tandon RK, Sato N, Garg PK. Consensus Study Group. 2002; Chronic pancreatitis: Asia-Pacific consensus report. J Gastroenterol Hepatol. 17:508–518. DOI: 10.1046/j.1440-1746.2002.02762.x. PMID: 11982735.
Article
5. Latifi R, McIntosh JK, Dudrick SJ. 1991; Nutritional management of acute and chronic pancreatitis. Surg Clin North Am. 71:579–595. DOI: 10.1016/S0039-6109(16)45435-6. PMID: 1904645.
Article
6. Williamson RC, Cooper MJ. 1987; Resection in chronic pancreatitis. Br J Surg. 74:807–812. DOI: 10.1002/bjs.1800740919. PMID: 3664247.
Article
7. Fine KD, Ogunji F. 2000; A new method of quantitative fecal fat microscopy and its correlation with chemically measured fecal fat output. Am J Clin Pathol. 113:528–534. DOI: 10.1309/0T2W-NN7F-7T8Q-5N8C. PMID: 10761454.
Article
8. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. 1997; Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 20:1183–1197. DOI: 10.2337/diacare.20.7.1183. PMID: 9203460.
9. Waldhäusl W, Bratusch-Marrain P, Gasic S, Korn A, Nowotny P. 1979; Insulin production rate following glucose ingestion estimated by splanchnic C-peptide output in normal man. Diabetologia. 17:221–227. DOI: 10.1007/BF01235858. PMID: 499682.
Article
10. . Gardner DG, Shoback D, editors. Appendix: normal hormone reference ranges. 2011. Greenspan's basic & clinical endocrinology. 9th ed. McGraw-Hill;New York:
11. Levy JC, Matthews DR, Hermans MP. 1998; Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 21:2191–2192. DOI: 10.2337/diacare.21.12.2191. PMID: 9839117.
Article
12. Ware JE Jr, Sherbourne CD. 1992; The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 30:473–483. DOI: 10.1097/00005650-199206000-00002. PMID: 1593914.
13. Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch CE. 1995; Quality of life in chronic pancreatitis--results after duodenum-preserving resection of the head of the pancreas. Pancreas. 11:77–85. DOI: 10.1097/00006676-199507000-00008. PMID: 7667246.
Article
14. Sakorafas GH, Farnell MB, Farley DR, Rowland CM, Sarr MG. 2000; Long-term results after surgery for chronic pancreatitis. Int J Pancreatol. 27:131–142. DOI: 10.1385/IJGC:27:2:131. PMID: 10862512.
Article
15. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. 1995; Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial. Ann Surg. 221:350–358. DOI: 10.1097/00000658-199504000-00004. PMID: 7726670. PMCID: PMC1234583.
Article
16. Prinz RA, Greenlee HB. 1981; Pancreatic duct drainage in 100 patients with chronic pancreatitis. Ann Surg. 194:313–320. DOI: 10.1097/00000658-198109000-00009. PMID: 7271348. PMCID: PMC1345358.
Article
17. Büchler MW, Friess H, Müller MW, Wheatley AM, Beger HG. 1995; Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg. 169:65–69. discussion 69–70. DOI: 10.1016/S0002-9610(99)80111-1. PMID: 7818000.
Article
18. Nealon WH, Thompson JC. 1993; Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified puestow procedure. Ann Surg. 217:458–466. discussion 466–468. DOI: 10.1097/00000658-199305010-00005. PMID: 8489308. PMCID: PMC1242821.
Article
19. Izbicki JR, Bloechle C, Knoefel WT, Rogiers X, Kuechler T. 1999; Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am. 79:913–944. DOI: 10.1016/S0039-6109(05)70051-7. PMID: 10470335.
Article
20. Negi S, Singh A, Chaudhary A. 2010; Pain relief after Frey's procedure for chronic pancreatitis. Br J Surg. 97:1087–1095. DOI: 10.1002/bjs.7042. PMID: 20632276.
Article
21. Pothula Rajendra VK, Sivanpillay Mahadevan S, Parvathareddy SR, Nara BK, Gorlagunta Ramachandra M, Tripuraneni Venkata AC, et al. 2014; Frey's pancreaticojejunostomy in tropical pancreatitis: assessment of quality of life. A prospective study. World J Surg. 38:3235–3247. DOI: 10.1007/s00268-014-2732-7. PMID: 25189439.
Article
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr