In some patients, endoscopic sphincterotomy is not successful or is not possible, and a surgery, transduodenal sphincteroplasty (TS), is indicated. Most commonly affected are patients that have repeated scarring after endoscopic treatment and those that have had prior stomach surgery, such as gastric bypass or ulcer surgery. In TS, an open surgery is performed under general anesthesia. An incision is made through the first part of the small bowel and the pancreas and bile ducts are identified and sewn open widely. Patients are in the hospital just under a week and potential complications include infection and pancreatitis. Successful pain relief occurs in approximately two-thirds of patients, dependent on patient selection. MUSC is recognized nationally for its surgical expertise in TS.
Occasionally, patients will have significant scarring within the pancreas itself, known as chronic pancreatitis. In these patients, pancreas removal (partial or total) may be more successful than TS for pain relief. Patients that undergo total pancreatectomy may benefit from islet autotransplantation. MUSC is one of a handful of centers in the US that offers islet autotransplantation for chronic pancreatitis.