The impact of surgical strategies on outcomes for pediatric chronic pancreatitis

Pediatr Surg Int. 2017 Jan;33(1):75-83. doi: 10.1007/s00383-016-3999-6. Epub 2016 Nov 4.

Abstract

Purpose: To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief.

Methods: Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated.

Results: Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7-20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included: longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2-5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006-0.57; OR 0.07; 95%, CI 0.01-0.89). However, these associations were not present in multivariate analysis.

Conclusion: In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.

Keywords: Children; Chronic pancreatitis; Hereditary pancreatitis; Pancreas divisum.

MeSH terms

  • Adolescent
  • Child
  • Female
  • Humans
  • Male
  • Pancreas / surgery*
  • Pancreas Transplantation / methods*
  • Pancreatectomy / methods*
  • Pancreaticojejunostomy / methods*
  • Pancreatitis, Chronic / surgery*
  • Practice Guidelines as Topic*
  • Probability
  • Transplantation, Autologous
  • Treatment Outcome
  • Young Adult