Dérivation chirurgicale du canal de Wirsung dans la pancréatite chronique

Abstract

In chronic pancreatitis complicated by disabling pain, surgical drainage of the Wirsung duct by a wirsungojejunostomy using a Roux-en-Y loop is efficient, as proven by an experience with this procedure described 45 years ago. Dilatation of the Wirsung duct is considered necessary to perform this anastomosis by nearly all authors. Other complications of pancreatitis (biliary stenosis, pseudocyst, rarely duodenal stenosis) can be treated during the same procedure by an appropriate drainage. Inconstant efficacy of wirsungojejunostomy has lead to development of technical variants, such as Frey's procedure which includes drainage of the whole Wirsung duct after the local resection of the head (Frey's procedure) which is presented is this chapter. Compared with pancreatectomies, drainage procedures (anastomoses following partial pancreatectomies are excluded) are associated with a lower immediate morbidity and probably a better long-term functional result, especially on the endocrine function. Finally, surgical drainage of the Wirsung duct is presently in « competition » with endoscopic drainage (transpapillary drainage by endoprosthesis) and respective indications of both techniques remain to be clarified.