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The role of surgery in chronic pancreatitis

Authors
  • Frola, Carlo1
  • Somasundaram, Murali1
  • Hariharan, Deepak1
  • Kolaityte, Valdone1
  • Mohandas, Shailesh1
  • Stättner, Stefan2
  • Yip, Vincent S.1
  • 1 The Royal London Hospital, Barts Hepato-Pancreato-Biliary Surgery, Whitechapel Rd, London, E1 1BB, UK , London (United Kingdom)
  • 2 Medical University of Innsbruck, Department of Visceral, Transplantation and Thoracic Surgery, Anichstraße 35, Innsbruck, 6020, Austria , Innsbruck (Austria)
Type
Published Article
Journal
European Surgery
Publisher
Springer Vienna
Publication Date
May 07, 2019
Volume
51
Issue
3
Pages
114–120
Identifiers
DOI: 10.1007/s10353-019-0591-z
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundChronic pancreatitis (CP) remains a complex condition resulting in significant morbidity and suffering in patients, often over a long period of time. Treatment is mostly centred on a conservative approach, with a variety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques.MethodsThis review provides an overview of current treatment options for CP, the literature search was performed via PubMed. Personal experiences from the authors on how to approach the disease from the surgeon’s perspective are added. The outline includes pathophysiologic aspects, classifications and patient-centred surgical approaches.ResultsThere has not been a standardized treatment for CP so far as clinical and radiological appearance of the disease have a wide range due to great heterogeneity of this complex disease; therefore, level 1 evidence for treatment of CP remains low. More recently, different approaches to surgical management have been trialled. With personalized surgery, long-term pain relief is achievable in up to 90% with low morbidity. Autologous islet cell transplantation is a feasible option in selected patients to avoid endocrine insufficiency.ConclusionA tailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. A multidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.

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