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Partial duodenopancreatectomy and occlusion of the remaining ductal system by Ethibloc® to induce rapid exocrine atrophy for treatment of severe chronic cephalic pancreatitis was introduced in our department in January of 1978. Since then, this surgical procedure has been performed in a total of 289 patients. Postoperative morbidity was 12.2%, 5 pancreatic and 3 biliary fistulas occurred. Postoperative mortality was 1% and relapses of pancreatitis occurred in only 2.2% due to incomplete filling of ducts with Ethibloc®. A total of 88.2% of patients became pain-free and symptomless, 10.8% voiced minor complaints, and 85.9% gained an averaged of 7.8 kg weight postoperatively.

The present investigation provides follow-up data (up to 36 months) of exocrine and endocrine pancreatic function, inflammatory activity, pain, and body weight in 23 chronic pancreatitis patients submitted to Whipple's procedure plus intraoperative Ethibloc occlusion of the remaining pancreatic duct system between January 1983 and February 1984. Clinically, Whipple's procedure plus intraoperative pancreatic duct occlusion resulted in almost complete and continuous cessation of pain as well as significant (p <0.05) increase in body weight. With regard to exocrine pancreatic function (Secretin-Pancreozymin test, plasma amino acid consumption test, Pankreolauryl test, fecal chymotrypsin determination), intraoperative pancreatic duct occlusion was shown to induce high-grade insufficiency and thus exocrine parenchymal atrophy in all patients. Simultaneously, the inflammatory process (represented by serum levels of trypsin, lipase, and pancreatic isoamylase) was terminated in all 23 patients. Endocrine pancreatic function, evaluated by serum levels of insulin and C-peptide measured under fasting conditions and subsequent maximal combined β-cell stimulation as well as corresponding integrated hormone releases, was reduced by partial pancreas resection by about 50, while there was no further impairment during the 36-month follow-up period in consequence of additional intraoperative pancreatic duct occlusion. Altogether, Whipple's procedure plus intraoperative Ethibloc occlusion of the residual pancreatic duct system seems suitable for termination of the inflammatory process and thus preservation of residual endocrine pancreatic function in chronic pancreatitis.

Lymphangiograms of canine cardiac and pulmonary efferent mediastinal lymphatics were made by cannulation and injection of Ethiodol®. Injections were made singly and serially. The mediastinal lymphatics and lymph nodes, which constitute the pathways of drainage of the heart and lungs, were delineated from the point of cannulation to the right and left inferior cervical region where the right lymphatic duct and thoracic duct are located. Lymphangiography reveals that the lymphatics which drain the heart and lungs may join to form common mediastinal lymphatic channels. Interconnections between mediastinal channels were demonstrated. The lymphatics terminated in the region of both the right lymphatic duct and thoracic duct in every subject. The so-called “cardiac node of Drinker” is usually a group of pretracheal nodes rather than a single node. The pretracheal nodes and those more cephalad receive drainage of lymph from both the heart and lungs. These studies suggest that lymph collected by cannulation of a “cardiac” lymphatic adjacent to the “cardiac node” will contain pulmonary as well as cardiac lymph. Thus the high flows reported by many investigators for “cardiac” lymph probably indicates that pulmonary lymph is mixed with cardiac lymph, and that the experimental data should be interpreted with this in mind.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue.

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Partial duodenopancreatectomy and occlusion of the remaining ductal system by Ethibloc®to induce rapid exocrine atrophy for treatment of severe chronic cephalic pancreatitis was introduced in our department in January of 1978. Since then, this surgical procedure has been performed in a total of 289 patients. Postoperative morbidity was 12.2%, 5 pancreatic and 3 biliary fistulas occurred. Postoperative mortality was 1% and relapses of pancreatitis occurred in only 2.2% due to incomplete filling of ducts with Ethibloc®. A total of 88.2% of patients became pain-free and symptomless, 10.8% voiced minor complaints, and 85.9% gained an averaged of 7.8 kg weight postoperatively. We conclude that Ethibloc®occlusion is highly effective in inducing complete exocrine atrophy, thus abolishing the inflammatory process and preventing relapses of chronic pancreatitis and preserving the endocrine function from further impairment. This was demonstrated by biochemical assays during a 36-month follow-up in a prospective study in 23 of 289 patients. Our results compare favorably with and are superior to results from any other operative procedure for chronic cephalic pancreatitis. We consider partial duodenopancreatectomy combined with Ethibloc®occlusion of the pancreatic duct the procedure of choice in the surgical treatment of severe chronic cephalic pancreatitis. La duodénopancréatectomie céphalique complétée par 1'occlusion du canal de Wirsung avec la colle Ethibloc®pour induire une atrophie exocrine rapide du parenchyme restant dans la pancréatite chronique a été introduite dans notre département dès janvier, 1978. Depuis nous avons réalisé cette intervention chez 289 patients. La morbidité postopératoire était de 12.2% (5 fistules pancréatiques et 3 fistules biliaires). La mortalité postopératoire était de 1%; la récidive de pancréatite chronique a été observée dans 2.2% des cas, attribuée à un remplissage incomplet des canaux. La douleur a disparu chez 88.2% des patients; 10.8% continuaient à se plaindre faiblement. Une reprise de poids de 7.8 kgs en moyenne a été observée chez 85.9% des patients après 1'intervention. Nous concluons que 1'occlusion par 1'Ethibloc®est très efficace pour provoquer 1'atrophie exocrine du parenchyme pancréatique, mettant fin au processus inflammatoire du pancréas et prévenant des récidives de pancréatite chronique, tout en évitant une aggravation de la fonction endocrine. Ceci a été démontré par des tests biologiques faits pendant 36 mois dans une étude prospective chez 23 des 289 patients. Nos résultats sont similaires ou meilleurs qu'avec tout autre procédé chirurgical pour la pancréatite chronique de la tête du pancréas. Nous considérons que la duodénopancréatectomie céphalique avec occlusion du canal de Wirsung est un procédé de choix dans le traitement chirurgical de la pancréatite chronique céphalique. La duodenopancreatectomía con oclusión del sistema ductal remanente con Ethibloc®(para inducir la rápida atrofia del tejido exocrino) como modalidad de tratamiento de la pancreatitis crónica cefálica, fue introducida en nuestro departamento en enero de 1978. A partir de esa época este procedimiento ha sido realizado en un total de 289 pacientes. La tasa de mortalidad postoperatoria fue de 12.2%; se presentaron 5 fístulas pancreáticas y 3 biliares. La tasa de mortalidad postoperatoria fue de 1% y la de recurrencia de la pancreatitis de sólo 2.2%, debida a llenamiento incompleto de los canales con Ethibloc®. El 88.2% de los pacientes quedó libre de dolor y de sintomatología, y 10.8% manifestó quejas menores. El 85.9% ganó peso, 7.8 kg en promedio, en la fase postoperatoria. Hemos concluído que la oclusión con Ethibloc®es altamente efectiva para inducir atrofia exocrina completa, con lo cual queda abolido el proceso inflamatorio y se logra la prevención de relapsos de la pancreatitis crónica y la conservación del tejido endocrino. Esto fue demostrado mediante determinaciones bioquímicas realizadas en un estudio prospectivo sobre 23 de 289 pacientes, en el curso de un período de seguimiento de 36 meses. Nuestros resultados se comparan favorablemente, y realmente son superiores, a los de cualquier otro procedimiento operatorio utilizado en el tratamiento de la pancreatitis crónica cefálica. Nosotros consideramos la duodenopancreatectomía parcial combinada con oclusión de los canales pancreaticos con Ethibloc®, el procedimiento de escogencia en el tratamiento de la pancreatitis crónica cefálica severa.