The treatment options have evolved over the past decades and are aimed to provide durable relief in pain with possible attempt to support or improve the failing endocrine and exocrine functions. Surgical treatment options have shown the potentials to provide superior long term results compared to the pharmacological and endoscopic modalities and are broadly divided in to drainage, resection and combination hybrid procedures.
The choice is based on the morphology of the main pancreatic duct, presence of head mass and associated complication of CP. Knowing the basic nature of the disease, total pancreatectomy seems a curative option but not without significant morbidities. There is recent paradigm shift towards organ sparing surgical procedures with reasonable success.Despite recent advancement in the treatment modalities for CP the overall quality of life remains moderate which need further addressal.
Indications for Surgery
Intractable pain remains the commonest indication. Other established indications are complications of CP, which can be biliary obstruction, duodenal obstruction, symptomatic pseudocysts, internal pancreatic fistulae or pancreatic ascites that fail to resolve after adequate conservative or endoscopic treatment, symptomatic portal hypertension subsequent to splenic or portal vein thrombosis, bleeding pseudoaneurysms and pancreatic head mass or suspicion of malignancy. Other controversial indications for surgery are prevention of exocrine or endocrine deficiency.