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PMID: 21174215 Published · ppublish English Journal Article Review

Chronic pancreatitis: modern surgical management.

Langenbeck's archives of surgery ·Vol. 396 ·No. 2 ·2011-02-00 ·Pages 139-49

Bachmann K, Izbicki JR, Yekebas EF

Abstract

Chronic pancreatitis (CP) is a disease with enormous social and personal impact. It is most commonly caused by the abuse of alcohol combined with nicotine. CP is usually characterised by an inflammatory mass located in the pancreatic head. Its natural course is characterised by persistent or recurrent painful attacks as well as progressive loss of pancreatic function due to fibrosis of the parenchyma with consecutive endocrine and exocrine insufficiency. The only success parameter of any treatment is the effective long-lasting pain relief and improvement in the quality of life. The surgical armamentarium includes simple drainage procedures, resections of different extents or a combination of both. Duodenum-preserving resection of the pancreas offers the best short-term outcome according to trials conducted so far. It has the benefit of combining the highest safety with the highest efficiency. Additionally, the extent of the operation can be adapted to the morphology of the individual patient.

MeSH Terms
Disease Progression Humans Pancreatitis, Chronic/complications,etiology,physiopathology,surgery
Authors & Affiliations
3 authors, click to expand affiliations / ORCID
Bachmann Kai
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. [email protected]
Izbicki Jakob R
Yekebas Emre F
References (87)
87 references, click to expand
  1. Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity.
    Br J Surg. 2008 Apr;95(4):447-52 PMID: 18161761
  2. [Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis].
    Chirurg. 1980 May;51(5):303-7 PMID: 7408575
  3. Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique.
    Radiology. 1995 Aug;196(2):459-64 PMID: 7617861
  4. Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis.
    Br J Surg. 2008 Mar;95(3):350-6 PMID: 17933005
  5. Internal pancreatic fistula.
    Am J Surg. 1992 Feb;163(2):216-20 PMID: 1739176
  6. Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management.
    ANZ J Surg. 2001 Apr;71(4):221-5 PMID: 11355730
  7. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head.
    World J Surg. 1990 Jan-Feb;14(1):83-7 PMID: 2305590
  8. Surgical treatment of chronic pancreatitis. Twenty-two years' experience.
    Ann Surg. 1979 Sep;190(3):312-9 PMID: 485605
  9. [Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation].
    Chirurg. 1995 Apr;66(4):350-9 PMID: 7634946
  10. Optimizing surgical therapy for chronic pancreatitis.
    Pancreatology. 2002;2(4):379-84; discussion 385 PMID: 12138226
  11. Surgical treatment of chronic pancreatitis and quality of life after operation.
    Surg Clin North Am. 1999 Aug;79(4):913-44 PMID: 10470335
  12. Endoscopic pancreatic duct stenting to treat pancreatic ascites.
    Gastrointest Endosc. 1999 Jun;49(6):710-5 PMID: 10343214
  13. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis.
    Ann Surg. 2008 Jun;247(6):950-61 PMID: 18520222
  14. The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis.
    Virchows Arch A Pathol Anat Histopathol. 1992;420(1):1-4 PMID: 1539444
  15. For which type of chronic pancreatitis is the "Hamburg procedure" indicated?
    J Hepatobiliary Pancreat Sci. 2010 Nov;17(6):758-62 PMID: 19779663
  16. Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis.
    J Gastrointest Surg. 2008 Dec;12(12):2087-95; discussion 2095-6 PMID: 18846404
  17. Management of biliary and duodenal complications of chronic pancreatitis.
    World J Surg. 2003 Nov;27(11):1258-70 PMID: 14534824
  18. Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis.
    Am J Surg. 1981 Jan;141(1):153-8 PMID: 6970001
  19. Chronic pancreatitis.
    N Engl J Med. 1995 Jun 1;332(22):1482-90 PMID: 7739686
  20. Duodenum-preserving pancreatic head resection--a randomized controlled trial comparing the original Beger procedure with the Berne modification (ISRCTN No. 50638764).
    Surgery. 2008 Apr;143(4):490-8 PMID: 18374046
  21. Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment.
    Int J Pancreatol. 1993 Dec;14(3):205-12 PMID: 8113622
  22. Combined pancreatic duct and upper gastrointestinal and biliary tract drainage in chronic pancreatitis.
    Arch Surg. 1985 Mar;120(3):361-6 PMID: 3970672
  23. Is it necessary to distinguish between alcoholic and nonalcoholic chronic pancreatitis?
    J Gastroenterol. 2007 Jan;42 Suppl 17:127-30 PMID: 17238041
  24. Chronic pancreatitis: etiology, pathogenesis, diagnosis, and treatment.
    Int J Colorectal Dis. 2003 Mar;18(2):97-106 PMID: 12548409
  25. Long-term results of endoscopic treatment of biliary duct obstruction due to pancreatic disease.
    Hepatogastroenterology. 1998 May-Jun;45(21):833-9 PMID: 9684143
  26. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial.
    Gastroenterology. 2008 May;134(5):1406-11 PMID: 18471517
  27. Duodenum-preserving pancreatic head resection: Long-term results.
    J Gastrointest Surg. 1997 Jan-Feb;1(1):13-9 PMID: 9834325
  28. Long-term follow-up of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis.
    Ann Surg. 2005 Apr;241(4):591-8 PMID: 15798460
  29. Description and rationale of a new operation for chronic pancreatitis.
    Pancreas. 1987;2(6):701-7 PMID: 3438308
  30. Do the diagnostic criteria differ between alcoholic and nonalcoholic chronic pancreatitis?
    J Gastroenterol. 2007 Jan;42 Suppl 17:118-26 PMID: 17238040
  31. Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis.
    Br J Surg. 1997 Apr;84(4):477-82 PMID: 9112896
  32. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.
    N Engl J Med. 2007 Feb 15;356(7):676-84 PMID: 17301298
  33. Redo-surgery following curative resection of pancreatic carcinoma: the difference between true and suspected recurrence.
    Dig Surg. 2009;26(3):222-8 PMID: 19468232
  34. Pancreatic surgery.
    Curr Opin Gastroenterol. 2000 Sep;16(5):426-30 PMID: 17031114
  35. Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited.
    Ann Surg. 2002 Jul;236(1):82-9 PMID: 12131089
  36. The role of endoscopy in patients with chronic pancreatitis.
    Gastrointest Endosc. 2006 Jun;63(7):933-7 PMID: 16733106
  37. Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis. Strategies for salvage.
    Arch Surg. 1994 Apr;129(4):374-9; discussion 379-80 PMID: 8154964
  38. A randomised, double blind, multicentre trial of octreotide in moderate to severe acute pancreatitis.
    Gut. 1999 Jul;45(1):97-104 PMID: 10369711
  39. Risk factors for diabetes mellitus in chronic pancreatitis.
    Gastroenterology. 2000 Nov;119(5):1324-32 PMID: 11054391
  40. Pancreatic ascites: study of therapeutic options by analysis of case reports and case series between the years 1975 and 2000.
    Am J Gastroenterol. 2003 Mar;98(3):568-77 PMID: 12650789
  41. Pancreatic ascites--a collected review of 37 cases in Japan.
    Hepatogastroenterology. 1989 Aug;36(4):244-8 PMID: 2478433
  42. Long-term follow-up in small duct chronic pancreatitis: A plea for extended drainage by "V-shaped excision" of the anterior aspect of the pancreas.
    Ann Surg. 2006 Dec;244(6):940-6; discussion 946-8 PMID: 17122619
  43. Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study.
    Am J Gastroenterol. 2003 Nov;98(11):2448-53 PMID: 14638347
  44. Thoracic manifestations of internal pancreatic fistulas: report of five cases.
    Am J Gastroenterol. 1989 Mar;84(3):265-71 PMID: 2645766
  45. Stenosis of the common bile duct in chronic pancreatitis.
    Br J Surg. 1982 Jan;69(1):52-4 PMID: 7053803
  46. Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis.
    Arch Surg. 1987 Apr;122(4):410-5 PMID: 3566522
  47. Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified puestow procedure.
    Ann Surg. 1993 May;217(5):458-66; discussion 466-8 PMID: 8489308
  48. Modified Puestow procedure for retrograde drainage of the pancreatic duct.
    Ann Surg. 1960 Dec;152:1037-43 PMID: 13733040
  49. Amylase levels in ascitic fluid.
    J Clin Gastroenterol. 1987 Apr;9(2):172-4 PMID: 2437177
  50. Frey procedure in the treatment of chronic pancreatitis: short-term results.
    Pancreas. 2006 Nov;33(4):354-8 PMID: 17079939
  51. Internal pancreatic fistulas: proposal of a management algorithm based on a case series analysis.
    J Clin Gastroenterol. 2004 Oct;38(9):795-800 PMID: 15365408
  52. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease.
    Digestion. 1993;54(3):148-55 PMID: 8359556
  53. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial.
    Ann Surg. 1995 Apr;221(4):350-8 PMID: 7726670
  54. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis.
    Ann Surg. 1994 Oct;220(4):492-504; discussion 504-7 PMID: 7524454
  55. Transpapillary stenting for pancreaticocutaneous fistulas.
    J Gastrointest Surg. 1997 Jul-Aug;1(4):357-61 PMID: 9834370
  56. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis.
    Pancreas. 1997 Apr;14(3):215-21 PMID: 9094150
  57. [Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study].
    Chirurg. 1997 Apr;68(4):369-77 PMID: 9206631
  58. Pain in chronic pancreatitis. Patients, patience, and the impatient surgeon.
    Gastroenterology. 1984 May;86(5 Pt 1):987-9 PMID: 6706079
  59. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients.
    Gastroenterology. 1984 May;86(5 Pt 1):820-8 PMID: 6706066
  60. Pathogenesis and the natural course of chronic pancreatitis.
    Eur J Gastroenterol Hepatol. 2002 Sep;14(9):929-34 PMID: 12352211
  61. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis.
    Am J Surg. 1987 Feb;153(2):207-13 PMID: 3812895
  62. Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis.
    Langenbecks Arch Surg. 2007 May;392(3):359-64 PMID: 17375317
  63. Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy.
    Ann Surg. 1998 Dec;228(6):771-9 PMID: 9860476
  64. Chronic pancreatitis with biliary obstruction.
    Ann R Coll Surg Engl. 1992 Mar;74(2):119-23; discussion 123-5 PMID: 1567130
  65. Pancreatic ascites in an infant: lack of symptoms and normal amylase.
    Dig Dis Sci. 2003 Sep;48(9):1701-4 PMID: 14560986
  66. Chronic pancreatitis--a surgeons' view.
    Med Sci Monit. 2008 Nov;14(11):RA198-205 PMID: 18971885
  67. Somatostatin in the treatment of pancreatic ascites.
    Gastroenterology. 1990 Nov;99(5):1520-1 PMID: 1698686
  68. Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical-surgical series of 500 patients.
    Br J Surg. 1998 Dec;85(12):1645-9 PMID: 9876067
  69. Reoperative surgery for chronic pancreatitis: is it safe?
    World J Surg. 2006 Jul;30(7):1321-8 PMID: 16794906
  70. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy.
    Langenbecks Arch Surg. 2006 Aug;391(4):338-42 PMID: 16680474
  71. Chronic pancreatitis: classification, relationship to acute pancreatitis, and early diagnosis.
    J Gastroenterol. 2007 Jan;42 Suppl 17:58-9 PMID: 17238029
  72. Long-term follow-up after organ-preserving pancreatic head resection in patients with chronic pancreatitis.
    J Gastrointest Surg. 2008 Feb;12(2):308-12 PMID: 17906905
  73. Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas.
    Br J Surg. 1994 Sep;81(9):1351-5 PMID: 7953411
  74. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis.
    Dig Surg. 2001;18(1):21-5 PMID: 11244255
  75. Chronic pancreatitis complicated by cavernous transformation of the portal vein: contraindication to surgery?
    Surgery. 2011 Mar;149(3):321-8 PMID: 20684965
  76. Surgical treatment of pancreatic ascites and pancreatic pleural effusions.
    Hepatogastroenterology. 1995 Sep-Oct;42(5):748-51 PMID: 8751245
  77. Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure.
    Ann Surg. 1998 Feb;227(2):213-9 PMID: 9488519
  78. Pathology of acute and chronic pancreatitis.
    Pancreas. 1993 Nov;8(6):659-70 PMID: 8255882
  79. Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria.
    Ann Surg. 1985 Dec;202(6):720-4 PMID: 4073984
  80. Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients.
    Dig Dis Sci. 1992 Mar;37(3):340-6 PMID: 1735356
  81. Surgical management of pancreatic pseudocysts, pancreatic ascites, and pancreaticopleural fistulas.
    Pancreas. 1991;6 Suppl 1:S66-75 PMID: 1788255
  82. Chronic pancreatitis: results of operations for relief of pain.
    World J Surg. 1990 Jan-Feb;14(1):53-8 PMID: 2407038
  83. Pancreatic surgery.
    Curr Opin Gastroenterol. 2002 Sep;18(5):568-73 PMID: 17033335
  84. [Pancreatico-bronchial fistula with communication to a pseudoaneurysm of the arteria lienalis as a rare complication in chronic pancreatitis].
    Z Gastroenterol. 1998 Dec;36(12):1047-51 PMID: 10025056
  85. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis.
    Am J Surg. 1995 Jan;169(1):65-9; discussion 69-70 PMID: 7818000
  86. Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum.
    World J Surg. 1990 Jan-Feb;14(1):59-69 PMID: 2407039
  87. Pancreatic redo procedures: to do or not to do -- this is the question.
    J Gastrointest Surg. 2007 Sep;11(9):1175-82 PMID: 17588191
Article Info
Journal
Langenbeck's archives of surgery
Abbr.
Langenbecks Arch Surg
ISSN
1435-2451
DOI
10.1007/s00423-010-0732-0
Email
[email protected]
Published
2011-02-00
Epub
2010-00-21
Pages
139-49
Language
English
Region
Germany
NLM ID
9808285
Subset
IM
External Links
PubMed source DOI: 10.1007/s00423-010-0732-0 View journal details
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