The Surgical Management of Chronic Pancreatitis

Abstract

procedures to address these mechanisms. Resection of diseased pancreatic tissue, in particular inflamed tissue within the head of the pancreas containing altered neural tissue and diseased ducts, considered the "pacemaker of disease" (Beger HG World J Surg 1990) and drainage of the pancreatic ductal system, in order to relieve ductal and parenchymal tissue hypertension. Removal of sufficient pancreatic tissue as to result in effective and d u r a b l e r e l i e f o f s y m p t o m s m u s t h o w e v e r b e b a l a n c e d a g a i n s t t h e d e s i r e t o a v o i d surgically related morbidity and mortality as well as to prevent post-operative pancreatic functional insufficiency. This has led to the development of less extensive resections and hybrid procedures which attempt to combine the advantages while avoiding the disadvantages of each approach. This chapter will describe the theories around the pathophysiology of pain in chronic pancreatitis, discuss the rationale and indications for surgical intervention and detail the procedures currently available. It will also review the literature guiding the choice of these procedures for the relief of pain.