[Surgical therapy in chronic pancreatitis]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatobiliary Surgery

Context:

• Chronic pancreatitis often necessitates surgical intervention when conservative management fails.
• Indications for surgery include intractable pain, duodenal, common bile duct, or pancreatic duct obstruction, and portal hypertension.
• Traditional Whipple resection, while effective for malignancies, has shown suboptimal long-term results and quality of life in chronic pancreatitis patients.

Purpose:

• To evaluate surgical treatment options for chronic pancreatitis, focusing on pancreatic head-related complications.
• To compare the efficacy and outcomes of classical Whipple resection, pylorus-preserving Whipple resection, and duodenum-preserving pancreatic head resection.
• To establish the duodenum-preserving pancreatic head resection as a new standard of care for chronic pancreatitis with pancreatic head complications.

Summary:

• The duodenum-preserving pancreatic head resection selectively removes the pancreatic head while preserving surrounding organs, avoiding the high incidence of postoperative diabetes mellitus seen with Whipple variations.
• This organ-preserving approach effectively resolves pancreatic head-related complications of chronic pancreatitis.
• Follow-up results demonstrate the superiority of the duodenum-preserving pancreatic head resection over classical and pylorus-preserving Whipple resections in terms of both short- and long-term outcomes.

Impact:

• The duodenum-preserving pancreatic head resection represents a significant advancement in surgical management of chronic pancreatitis.
• This procedure improves patient quality of life by minimizing postoperative complications, particularly diabetes mellitus.
• Adoption of this organ-preserving technique as a new standard can enhance surgical outcomes for patients with chronic pancreatitis.