[Duodenum-preserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne...

In chronic pancreatitis chronic pain is the most frequent indication for surgery. Because symptoms are often caused or maintained by an inflammatory mass in the head of the pancreas, resection procedures are superior to pure surgical drainage. The pancreatoduodenectomy (PD) and the duodenum-preserving pancreatic head resection (DPPHR) are safe and effective techniques resulting in long-lasting pain relief in about 80% of patients. Randomized controlled trials (RCTs) show initial functional advantages for the organ-preserving DPPHR compared to PD, but these advantages are lost during follow-up, most likely because neither operation prevents a progressive loss of exocrine and endocrine function. Nevertheless the less invasive DPPHR should be regarded as the procedure of choice. The technique of DPPHR described by Beger was modified by Frey to an extended drainage procedure with local head excision; the Berne modification offers a technically less demanding option with comparable extent of resection. While results in terms of pain relief, quality of life and organ function are comparable between the three DPPHR techniques, the technical aspect of a simpler procedure favors the Berne modification.