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Surgical therapy in chronic pancreatitis
1Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.
Current Opinion in General Surgery
|January 1, 1993
Summary
Medical management is the first step for chronic pancreatitis. Surgery is indicated for refractory pain or complications, with specific procedures like pancreaticojejunostomy or Whipple resection based on pancreatic duct evaluation.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Chronic pancreatitis management requires careful consideration of medical versus surgical interventions.
- Pain refractory to medical therapy is a primary driver for surgical consultation in chronic pancreatitis patients.
Purpose of the Study:
- To outline the current surgical indications and procedural recommendations for chronic pancreatitis.
- To detail the preoperative imaging and surgical strategies for managing chronic pancreatitis.
Main Methods:
- Preoperative evaluation involves dynamic computed tomography (CT) scans to assess the pancreas and pancreatic duct.
- Endoscopic retrograde cholangiopancreatography (ERCP) is utilized when CT is inconclusive for pancreatic duct visualization or dilation.
- Surgical interventions are selected based on pancreatic duct diameter and disease localization.
Main Results:
- Pancreatic duct dilation >5 mm in symptomatic patients warrants a side-to-side pancreaticojejunostomy.
- Non-dilated ducts with other pain causes ruled out suggest pylorus-preserving Whipple or duodenum-preserving pancreatic head resection.
- Distal pancreatectomy is for tail-isolated disease; total pancreatectomy is a salvage option with potential for autotransplantation.
Conclusions:
- Surgical intervention for chronic pancreatitis is reserved for specific indications, primarily intractable pain and complications.
- Imaging plays a crucial role in guiding surgical decision-making for chronic pancreatitis.
- A range of surgical procedures exist, tailored to the specific anatomy and pathology of chronic pancreatitis.