The effect of the modified puestow procedure on diabetes in patients with tropical chronic pancreatitis--a prospective study

OBJECTIVES: Surgical decompression of the pancreatic duct in patients with chronic pancreatitis relieves pain in 80-90% of subjects, but its effect on exocrine and endocrine pancreatic function is not clear. We sought to further examine such effects. METHODS: We performed the modified Puestow procedure (lateral pancreaticojejunostomy) in 53 patients with chronic tropical pancreatitis. Pain evaluation was done subjectively and objectively, and the fasting and postprandial blood glucose, insulin requirements, and 72-h fecal fat levels were estimated before and at 3 months and 5 yr after operation. We compared 46 operated patients who completed 5 yr of follow-up with 40 patients who did not undergo operation. RESULTS: Forty-one patients (89%) had complete pain relief. The mean fasting (209 mg/dl) and postprandial (320 mg/dl) blood glucose and insulin requirements (40 U/day) decreased postoperatively (fasting, 162 mg/dl; postprandial blood glucose, 254mg/dl; insulin requirement, 18.2 U/day; p < 0.01), and steatorrhea improved in one of six patients. In the nonoperated group, endocrine and exocrine pancreatic function remained unchanged. CONCLUSIONS: Patients with tropical chronic pancreatitis who undergo the Puestow procedure not only have relief from pain but also improvement of diabetes.