Short and long-term post-operative outcomes of duodenum preserving pancreatic head resection for chronic pancreatitis affecting the head of pancreas: a systematic review and meta-analysis

• Published in: HPB (Oxford, England) Vol. 18; no. 2; pp. 121 - 128
• Main Authors: Jawad, Zaynab A.R, Tsim, Nicole, Pai, Madhava, Bansi, Dev, Westaby, David, Vlavianos, Panagiotis, Jiao, Long R
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2016; Elsevier
• Subjects: Abdominal Pain - etiology; Adult; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatectomy - mortality; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - diagnosis; Pancreatitis, Chronic - mortality; Pancreatitis, Chronic - surgery; Postoperative Complications - etiology; Review; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2015.10.003

Abstract Background To evaluate the short and long term outcomes of duodenum preserving pancreatic head resection (DPPHR) procedures in the treatment of painful chronic pancreatitis. Methods A systematic literature search was performed to identify all comparative studies evaluating long and short term postoperative outcomes (pain relief, morbidity and mortality, pancreatic exocrine and endocrine function). Results Five published studies fulfilled the inclusion criteria including 1 randomized controlled trial comparing the Beger and Frey procedure. In total, 323 patients underwent surgical procedures for chronic pancreatitis, including Beger (n = 138) and Frey (n = 99), minimal Frey (n = 32), modified Frey (n = 25) and Berne's modification (n = 29). Two studies comparing the Beger and Frey procedure were entered into a meta-analysis and showed no difference in post-operative pain (RD = −0.06; CI −0.21 to 0.09), mortality (RD = 0.01; CI −0.03 to 0.05), morbidity (RD = 0.12; CI −0.00 to 0.24), exocrine insufficiency (RD = 0.04; CI −0.10 to 0.18) and endocrine insufficiency (RD = −0.14 CI −0.28 to 0.01). Conclusion All procedures are equally effective for the management of pain for chronic pancreatitis. The choice of procedure should be determined by other factors including the presence of secondary complications of pancreatitis and intra-operative findings. Registration number CRD42015019275. Centre for Reviews and Dissemination, University of York, 2009.