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Pancreatitis%20-%20chronic Treatment
Surgical Intervention
- Early surgical intervention may more effectively relieve pain, decrease the need for re-intervention and improve pancreatic function preservation
- Surgery may be considered in the following groups of patients:
- With persistent pain unresponsive to medical therapy
- Patients whose pancreatic ductal anatomy is not suitable for endoscopic treatment
- Patients in whom endoscopic therapy has failed
- Surgery is superior to endoscopy for control of pain in a dilated pancreatic duct
- Presence of complications, eg infection or symptomatic compression of adjacent structures
- As 1st-line treatment for suspected pancreatic cancer
- Procedures that may be performed are pseudocyst decompression, ductal decompression, pancreatic resection, denervation procedures, and total pancreatectomy
- The choice of procedure depends on the patient’s predominant condition, though more preferred are the tissue-preserving procedures
- Ductal dilatation is best treated with drainage and decompression procedures
- “Small-duct” disease is usually treated with pancreatic resection
- Pseudocysts >5 cm in size and persisting for >6 months should be drained
- Refractory chronic pain in highly selected patients is treated with total pancreatectomy with islet autotransplant only when all other treatment measures are unsuccessful
