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J Gastrointest Surg. 2016 Apr;20(4):734-40. doi: 10.1007/s11605-016-3081-7. Epub 2016 Jan 26.

Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure.

Author information

1
Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
2
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
3
Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
4
Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
5
Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
6
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
7
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
8
Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vsingh1@jhmi.edu.
9
Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vsingh1@jhmi.edu.

Abstract

BACKGROUND:

Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

METHODS:

All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis.

RESULTS:

A total of 60 patients (age 51.6 years, 53% males) were included in our study, of whom 42 (70%) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62%) patients with toxic etiology, 36 (60%) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p < 0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95% CI 1.3, 24.5, p = 0.02).

CONCLUSION:

Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

KEYWORDS:

Alcohol; Chronic pancreatitis; Post-operative pain relief; Smoking

PMID:
26813017
DOI:
10.1007/s11605-016-3081-7
[Indexed for MEDLINE]

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