• Giuseppe Garcea, James Weaver, John Phillips, Cristina A Pollard, Severine C Ilouz, M'balu A Webb, David P Berry, and Ashley R Dennison.
• Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, United Kingdom. gg43@le.ac.uk
• Pancreas. 2009 Jan 1;38(1):1-7.

ObjectivesThis study examined 85 consecutive patients undergoing total pancreatectomy (+/-islet cell transplant), examining pain relief, insulin requirements, and glycemic control postoperatively.MethodsA prospective database of all patients undergoing total pancreatectomy for chronic pancreatitis was used to record preoperative and postoperative details from 1996 to 2006.ResultsThere were 3 postoperative deaths (1 islet recipient and 2 nonislet patients). The median number of acute admissions for pain fell from 5 to 2 after pancreatectomy, and the median length of stay from 6.2 days to 3.3 days. At 12 months postoperatively, the number of patients on regular opiate analgesia fell from 90.6% to 40.2% and by 5 years to 15.9%. There was a significant reduction in the patients' visual analogue pain score after surgery from 9.7 to 3.7 (P < 0.001). Five patients were insulin independent at 5 years. Median 24-hour insulin requirements were significantly lower in the islet group (15.5 vs 40 units at 5 years postoperatively; P < 0.001).ConclusionsTotal pancreatectomy is effective in reducing pain and dependence on opioid analgesia in patients with chronic pancreatitis. The addition of an islet cell transplant results in a reduction in 24-hour insulin demands, as well as potentially achieving insulin independence.

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