[Surgical treatment of chronic pancreatitis]

The surgical treatment of chronic pancreatitis has benefited from the progress in imaging, with subsequent improvement of preoperative investigations but the main factor has been the development of surgical procedures. The pancreatectomy with the preservation of the pylorus or duodenum completes the armamentarium of by-pass and resective techniques. The classical surgical indications are the local evolutive complications: obstruction of pancreatic duct, common bile duct stenosis, duodenal stenosis, splenic complications and localized extra-hepatic portal hypertension. Other indications are intractable chronic pain and pseudotumoral inflammatory lesions of the head of the pancreas that may be indistinguishable from cancer. In the surgical treatment of chronic pancreatitis, the operative mortality is similar with exploratory laparotomy, pancreatic by-pass, cysto-anastomosis and the Whipple procedure. 5 and 10 year actuarial survival rates are 92% and 76% with resections, 80% and 54% with cysto-anastomosis, 85% and 66% with pancreatic by-pass, respectively. Functional results are excellent with the absence of pain in 76% of patients following resection or by-pass.