[Is a Whipple operation in chronic pancreatitis still a current procedure?]

Until the eighties, the surgical procedure of choice in chronic pancreatitis with an inflammatory mass in the head of the pancreas has been partial duodenopancreatectomy (pDP). Since neither stomach, duodenum nor the common bile duct are directly involved in the inflammatory process of the pancreas, the Whipple's procedure (pDP) might lead to overtreatment. Therefore, duodenum-preserving pancreatic head resection (DPPHR), developed by Beger in 1972, has become in several centers the standard procedure for patients with an inflammatory enlargement of the head of the pancreas. We reviewed the literature of the last ten years and evaluated the different surgical procedures for pancreatic head resection. Comparing pDP and DPPHR. Whipple procedure has a higher hospital mortality (3.2% versus 0.6%), a higher late mortality (22% versus 8.4%), a higher morbidity and a higher incidence of a new "surgical" diabetes (17.6% versus 2%). With regard to relief of pain long-term investigations show totally pain-free patients after pDP in 72%, after pylorus-preserving duodenopancreatectomy (PPDP) in 82% and after DPPHR in 89%. Furthermore, other disadvantages of PPDP are the high rate of gastric outlet dysfunction (17% on average with a range of 4-32%) and the high rate of marginal ulcers (8.4% on average with a range of 5-11%). In summary, we conclude that in patients with chronic pancreatitis and an inflammatory enlargement of the pancreatic head. DPPHR is the procedure of choice. Whipple's procedure should only be performed if a suspicion of malignancy is suspected or, secondly, if a patient suffers from persistent pain (5%) after DPPHR.