Surgical management of chronic relapsing pancreatitis

Chronic relapsing pancreatitis is a syndrome usually associated with chronic alcohol abuse, and is characterized by pain in the upper abdomen and back, weight loss, and disturbances in function of the endocrine and exocrine pancreas. A surgical attack on this disorder can be traced to the turn of the century, when experimental work suggested the feasibility of operations of the pancreas. In 1911 Link performed pancreatostomy for this disease and achieved an excellent long-term result. Later, partial or total pancreatectomy was introduced in the management of this condition. With pathologic evidence of pancreatic duct dilatation, attempts at retrograde drainage of the duct into the gastrointestinal tract were introduced in the 1950s, with encouraging results. The recent advent of diagnostic modalities capable of more precise definition of ductal anatomy allows more discriminate application of the two major surgical approaches of resection and internal drainage. In this review, the literature concerning this interesting subject is surveyed and the favored diagnostic and surgical methods are assessed.