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 M. Colombani

Research output: Contribution to journalReview articlepeer-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)75-83
Number of pages9
JournalPediatric surgery international
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Children
  • Chronic pancreatitis
  • Hereditary pancreatitis
  • Pancreas divisum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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