Chronic pancreatitis is an inflammatory disease resulting in permanent structural and functional changes in the pancreas which manifest clinically as abdominal pain. Operative treatment is indicated when maximal medical therapy has failed, and success in relieving pain is predicated on matching the correct operation (duct drainage, resection, denervation) to the patient's underlying pancreatic anatomy. When the pancreatic duct is dilated (>7 mm in diameter) and the gland morphology is homogeneous, a lateral pancreaticojejunostomy results in pain relief in 87% of patients with a low operative morbidity and mortality rate. A dilated duct with an enlarged pancreatic head requires local resection of the pancreatic head combined with a lateral pancreaticojejunostomy (Frey procedure). Small duct (<7 mm in diameter) disease with an enlarged head requires a Whipple-type pancreaticoduodenectomy or duodenal-preserving pancreatic head resection (Beger or Frey procedure). Both of these options achieve pain relief in approximately 89% of patients. Distal pancreatic resection is used only in the small subset of patients with distal obstructive pancreatitis. Bilateral videoassisted thoracoscopic splanchnicectomy may prove useful in controlling abdominal pain in patients with small duct or minimal change pancreatitis in up to 85% of patients, but further investigation is needed. In summary, operative success in achieving pain relief in patients with chronic pancreatitis is maximized by the careful application of drainage procedures, pancreatic resection, or nerve ablation techniques to patients based on the size of their pancreatic duct and gland morphology.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging