Surgical therapy of chronic pancreatitis: Indications, techniques and results

In chronic pancreatitis (CP) a benign inflammatory process in the pancreas results in progressive structural changes with replacement of functional exocrine and endocrine parenchyma by a fibrotic and inflammatory tissue, often evident as an inflammatory mass. The consequences are diabetes mellitus, exocrine insufficiency, and severe recurrent upper abdominal pain, often resulting in a significant reduction in the quality of life. The inflammatory process or the formation of pseudocysts can cause local complications such as obstruction of the pancreatic duct, bile duct or the duodenum. In spite of intensive research there is still no specific therapy for CP. Medical pharmacologic treatment is the basis of therapy in CP and aims at pain relief and treatment of exocrine and endocrine insufficiency. However, many patients require additional therapy for effective pain relief or treatment of local complications. Whereas a lot of these patients undergo repetitive endoscopic interventions, surgical drainage results in better long-term outcome. In patients with an inflammatory mass of the pancreatic head, surgical resection procedures provide good short and long-term results, especially in terms of pain relief. This article summarizes indications and potential of endoscopic/interventional and surgical therapy and gives an overview of surgical techniques with special focus on organ-sparing procedures such as the duodenum-preserving pancreatic head resection and its variants. Whereas exocrine and endocrine insufficiency may progress, adequate surgical therapy can provide effective long-term pain relieve and improvement in the quality of life in patients with CP.