[Evolution of the surgical treatment of chronic pancreatitis over the last 25 years]

The author briefly reminds us of the physiopatholopy of chronic pancreatitis (CP) and of its two principal surgical therapies: the excision (mainly cephalic or caudal) and the derivations (essentially towards an excluded jejunal ring). In order to avoid such a mutilation, either pancreatic or jejunal for the treatment of obstructive "pancreatic lithiasis", the author proposes to classify the lesional repercussions in cavitary CP (in which the existence of a pseudocyst is dominant) and in parenchymatous CP (ensheating the ducts, that are more or less dilated). He infers from this the possibility of a treatment that is as physiological as possible, essentially by cystoduodenostomy (CD) with a tripod forceps, for CP with a dominant cavitary type (with pseudocysts showing a cephalic and/or a corporeocaudal localization) and by wirsungosphincteroclasia (W-SC) for the CP with a parenchymatous prevalence. This therapeutic evolution, aiming at abandoning the classical operations of excision or derivation is based upon the author's experience acquired since 1970. During these 25 years, the author operated on 549 patients showing a CP with several severe evolutive complications. Beside 75 exopancreatic operations, the author performed 474 operations selectively concerning the pancreas: 245 excision operations and 228 derivation operations. Since the introduction, in October 1986, of the W-SC operation, among the 169 recent pancreatic operations for severe CP, only 10 exeresis operations were performed: 66 CD (41.5%) and W-SC 92 (57.9%), coupled in two thirds of the cases with a biliodigestive cholecystoplasty. The very encouraging results of this more physiological and non-mutilating treatment of severe CP justify, according to the author, forsaking the classical techniques of parenchym-exeresis or of derivation to an excluded ring an favour of a direct drainage into the duodenum both for a cavitary CP by CD as for a parenchymatous CP by W-SC.