Assessment of Decompressive Surgeries as a Pain Relief in Case of Chronic Pancreatitis

Abstract

Saikalyan Guptha A, Ravi Kumar H*, Sidduraj Sajjan, Siva Shankar, Sowmya C U and Yeshwanth S

Objective: Chronic calcific pancreatitis is a debilitating disease which requires early diagnosis and treatment in the form of medical therapy, interventional, endoscopic and surgical management. Our study included LPJ as the decompressive surgery which significantly improved the quality of life, better symptomatic relief, improvement in the exocrine and endocrine function of the pancreas with less recurrence rates as compared to other studies. The recurrence in pain was managed interventional with celiac plexus block. Other symptoms require long term follow up and there is constant need to improve the surgical procedures, endoscopic interventions and other form of medical therapy for chronic calcific pancreatitis due to its late presentation, irreversible nature and the amount of morbidity it causes. All the therapies require constant follow up due to high recurrence rates. According to our study decompressive surgery yields the better results as a symptomatic relief. However, there needs to be multidisciplinary approach for the treatment of chronic calcific pancreatitis.

Methods: All the patients of Chronic Pancreatitis admitted to the department of General Surgery at Vydehi Institute of Medical Sciences and Research Institute, Bengaluru during the period of October 2018 to September 2020 who consented for the procedure. Data was collected from a case recording proforma pertaining to patients’ particulars, history, clinical examinations, investigations, diagnosis and surgical procedures.

Results: Mean pain score at pre-op was 6.70 ± 1.06, at 12 hrs was 7.93 ± 1.01, at 1 week was 5.07 ± 1.57, at 6 months was 3.80 ± 1.99 at 12 months was 1.93 ± 1.36. There was significant decrease in mean Pain score at 12 hrs 1 week, 6 months and 12 months compared to pre op pain score. Mean HbA1c at pre op was 9.19 ± 2.72 and at postop was 8.15 ± 2.61. There was significant difference in mean HbA1c at postop compared to preop, which improved the endocrine function of the pancreas significantly. 30% had pain, 6.7% had steatorrhea. There is recurrence of symptoms in 36.7% of the patients after the procedure and was managed by coeliac plexus block- Postop at 6 months in 16.7%.

Conclusion: There is significant improvement in the exocrine, endocrine and symptomatic relief for the patients who underwent decompressive surgeries for chronic calcific pancreatitis with no significant difference between the types of surgeries performed. Hence, in conclusion decompressive surgeries are effective management of chronic pancreatitis after failed medical management in all those meeting, the criteria of operative management.