Gastro-intestinale chirurgie en gastro-enterologie. VI. Chronische pancreatitis: Chirurgische aspecten

The indications for surgical treatment of chronic pancreatitis are intractable pain or local complications. - The purpose of preoperative investigation, apart from establishing the indications for operation, is to select the kind of procedure to be performed. Important factors include narrowing or dilatation of the pancreatic duct and the presence or absence of an inflammatory mass in the pancreas and of pseudocysts. - A pylorus preserving pancreatoduodenectomy or duodenum preserving pancreatic head resection is performed in case of an inflammatory mass in the pancreatic head. In limited clinical trials, duodenum-preserving resection was associated with better recovery, this also applies to the Frey procedure, consisting of local resection of the pancreatic head in combination with lateral pancreaticojejunostomy. - In case of dilatation of the pancreatic duct (> 8 mm), without an inflammatory mass drainage of the pancreatic ductal system by a lateral pancreaticojejunostomy is appropriate. - A pancreatic tail or body resection can be performed for inflammatory lesions confined to the pancreatic tail or body. -Symptomatic pseudocysts are drained internally into the stomach, duodenum or a jejunal loop.