Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients

G. L. Nardi, F. Michelassi, P. Zannini

Research output: Contribution to journalArticle

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Abstract

Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94%) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2% (4 patients). Fifty-six patients (66%) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p <0.05) and frequent diarrhea (X2 = 6.18, p <0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p <0.01), heavy alcohol intake (X2 = 4.71, p <0.05), narcotic use (X2 = 5.68, p <0.05) and frequent diarrhea (X2 = 4.8, p <0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82%). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) has a successful long-term outcome compared with those without such a rise (MPT-) (61% v 41%, X2 = 5.13, p <0.05). Furthermore, of the patients with a successful short-term outcome, 88% with MPT+ remained long-term symptom-free compared to 38.5% with MPT- (X2 = 8.36, p <0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations signs of more advanced pancreatic disease, preoperative narcotic use, and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined groups with different short- and long-term prognosis after TPS.

Original languageEnglish
Pages (from-to)453-461
Number of pages9
JournalAnnals of Surgery
Volume198
Issue number4
Publication statusPublished - 1983

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Transhepatic Sphincterotomy
Neostigmine
Morphine
Pancreatitis
Diarrhea
Opioid-Related Disorders
Pancreatic Diseases
Life Tables
Narcotics
Chronic Pancreatitis
Alcoholism

ASJC Scopus subject areas

  • Surgery

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Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients. / Nardi, G. L.; Michelassi, F.; Zannini, P.

In: Annals of Surgery, Vol. 198, No. 4, 1983, p. 453-461.

Research output: Contribution to journalArticle

Nardi, GL, Michelassi, F & Zannini, P 1983, 'Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients', Annals of Surgery, vol. 198, no. 4, pp. 453-461.
Nardi, G. L. ; Michelassi, F. ; Zannini, P. / Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients. In: Annals of Surgery. 1983 ; Vol. 198, No. 4. pp. 453-461.
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abstract = "Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94{\%}) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2{\%} (4 patients). Fifty-six patients (66{\%}) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p <0.05) and frequent diarrhea (X2 = 6.18, p <0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p <0.01), heavy alcohol intake (X2 = 4.71, p <0.05), narcotic use (X2 = 5.68, p <0.05) and frequent diarrhea (X2 = 4.8, p <0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82{\%}). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) has a successful long-term outcome compared with those without such a rise (MPT-) (61{\%} v 41{\%}, X2 = 5.13, p <0.05). Furthermore, of the patients with a successful short-term outcome, 88{\%} with MPT+ remained long-term symptom-free compared to 38.5{\%} with MPT- (X2 = 8.36, p <0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations signs of more advanced pancreatic disease, preoperative narcotic use, and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined groups with different short- and long-term prognosis after TPS.",
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N2 - Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94%) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2% (4 patients). Fifty-six patients (66%) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p <0.05) and frequent diarrhea (X2 = 6.18, p <0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p <0.01), heavy alcohol intake (X2 = 4.71, p <0.05), narcotic use (X2 = 5.68, p <0.05) and frequent diarrhea (X2 = 4.8, p <0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82%). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) has a successful long-term outcome compared with those without such a rise (MPT-) (61% v 41%, X2 = 5.13, p <0.05). Furthermore, of the patients with a successful short-term outcome, 88% with MPT+ remained long-term symptom-free compared to 38.5% with MPT- (X2 = 8.36, p <0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations signs of more advanced pancreatic disease, preoperative narcotic use, and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined groups with different short- and long-term prognosis after TPS.

AB - Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94%) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2% (4 patients). Fifty-six patients (66%) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p <0.05) and frequent diarrhea (X2 = 6.18, p <0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p <0.01), heavy alcohol intake (X2 = 4.71, p <0.05), narcotic use (X2 = 5.68, p <0.05) and frequent diarrhea (X2 = 4.8, p <0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82%). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) has a successful long-term outcome compared with those without such a rise (MPT-) (61% v 41%, X2 = 5.13, p <0.05). Furthermore, of the patients with a successful short-term outcome, 88% with MPT+ remained long-term symptom-free compared to 38.5% with MPT- (X2 = 8.36, p <0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations signs of more advanced pancreatic disease, preoperative narcotic use, and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined groups with different short- and long-term prognosis after TPS.

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