The impact of surgical strategies on outcomes for pediatric chronic pancreatitis

Maria G. Sacco Casamassima, Seth D. Goldstein, Jingyan Yang, Colin D. Gause, Fizan Abdullah, Avner Meoded, Martin A Makary, Paul Colombani

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalPediatric Surgery International
DOIs
StateAccepted/In press - Nov 4 2016

Keywords

  • Children
  • Chronic pancreatitis
  • Hereditary pancreatitis
  • Pancreas divisum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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