Chapter-06 Surgery for Chronic Pancreatitis

BOOK TITLE: Recent Advances in Surgery 33

1. Johnson Colin D
Publishing Year
Author Affiliations
1. University Surgical Unit, Southampton General Hospital, Southampton, UK, Southampton General Hospital, Southampton, UK, University Hospital Southampton, Southampton, UK
Chapter keywords


Surgical procedures for relief of pain in chronic pancreatitis are more likely to be effective than various endoscopic techniques. Patients without pancreatic duct dilatation (the majority in most series) are not suitable for endoscopic therapy. The operation should be tailored to the individual patient and pancreatic morphology. The aim should be to adequately decompress the whole pancreas. If the pancreatic duct is dilated this aim can be achieved by lateral pancreaticojejunostomy. Often however, there is a mass of inflammatory tissue in the head of the pancreas and this must be resected. Chronic pancreatitis is an incurable condition with a spectrum of severity from mild to very severe. Symptoms may have an adverse effect on the quality of life and complications may require admission to hospital and may be life threatening. The usual clinical presentation is with upper abdominal pain, followed after a variable period of time by pancreatic exocrine insufficiency and/or diabetes mellitus. Strong analgesia is required to deal with the debilitating pain and the metabolic and nutritional disturbances may lead to severe cachexia and increased susceptibility to infection. Nerve ablation by celiac plexus block or splanchnicotomy can relieve pain, but the effect is usually short-lived. Decompression of the pancreas spares a ranged of procedures from lateral pancreaticojejunostomy to resection of the pancreatic head. Easily operation effectively prevents loss of function in patients with dilated pancreatic duct. Trial evidence shows that endoscopy for duct obstruction may delay surgery, but operation has greater long-term success. Pain relief is achieved in the long term for 70-80% of patients who have surgery. Organ sparing resection has better short-term results than pancreaticoduodenectomy.

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