Surgery of chronic pancreatitis

Chronic pancreatitis is a progressive disease of multiple etiologies. Surgery is frequently indicated for relief of debilitating pain as well as to address other complications, and three operations have proven effective. The pancreatico-duodenectomy (Whipple) procedure results in excellent long-term pain relief, but is associated with a low mortality rate and a persistent risk of early and late complications. The duodenum-preserving pancreatic head resection (DPPHR) introduced by Beger et al, and the local resection of the pancreatic head with longitudinal pancreatico-jejunostomy (LR-LPJ) devised by Frey, achieve the same high rate of pain relief long term but are associated with lower rates of perioperative complications and a decreased incidence of diabetes long term. All 3 operations address the head of the pancreas as the nidus of persistent inflammation, and all 3 achieve success with both dilated and nondilated duct disease. The LR-LPJ has a lower risk of perioperative problems and may be easier to perform.