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Surgery for chronic pancreatitis

Author
Katherine Morgan, MD, FACS
Section Editor
Stanley W Ashley, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Chronic pancreatitis (CP) is a benign, inflammatory disorder of the pancreas resulting in fibrotic replacement of the pancreatic parenchyma. The clinical presentation of CP is marked by severe, refractory abdominal pain. CP often leads to progressive endocrine failure (type 3c diabetes mellitus [1]) and exocrine failure (malabsorption with attendant nutritional compromise) of the pancreas.

Clinical management of CP is challenging, given incomplete understanding of disease pathogenesis and the complexities of pain control. Initial management of CP entails risk factor modification with alcohol abstinence and tobacco cessation, treatment of pain (ideally) with supportive behavioral therapy, and nutritional optimization with pancreatic enzyme replacement. Patients who continue to have debilitating pain despite best medical management are candidates for therapeutic intervention.

We discuss the indications, techniques, and outcomes of surgery for chronic pancreatitis in this topic. Nonsurgical treatments of chronic pancreatitis and surgical treatments of other pancreatic diseases are discussed in other topics. (See "Treatment of chronic pancreatitis" and "Surgical resection of lesions of the head of the pancreas" and "Surgical resection of lesions of the body and tail of the pancreas" and "Total pancreatectomy".)

ENDOSCOPY VERSUS SURGERY

For patients with chronic pancreatitis (CP) who require therapeutic intervention, endoscopic approaches are usually undertaken before surgery, owing to the perception that less invasive procedures should be attempted first. The optimal timing of surgery for patients who fail endoscopic interventions, however, is debated.

A 2015 Cochrane review suggested that for CP, surgery is superior to endoscopy in achieving lasting pain relief, and that early surgical intervention may help preserve pancreatic function [2]. Included in the Cochrane review are two randomized trials that compared endoscopic with surgical treatment of CP:

            
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Literature review current through: Sep 2017. | This topic last updated: Sep 25, 2017.
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