Surgery for Chronic pancreatitis
Pancreatic surgery for the treatment of chronic pancreatitis is complex. It can be an effective treatment to control the chronic debilitating pain associated with chronic pancreatitis.
The surgery for chronic pancreatitis mainly aims to control the chronic pain from the disease process. The operation also helps to relieve obstruction in the pancreatic duct or bile duct.
The three common operations are:
- Puestow’s procedure
- Duodenum-Preserving Pancreatic Head Resection (DPPHR)
- Whipple operation
Puestow’s procedure involves the connection of the entire length of pancreatic duct to a loop of the small intestines. This facilitates the drainage of pancreatic juice directly into the small intestine. The operation can be done either by open surgical technique or through a laparoscopic key-hole technique. The laparoscopic technique has the benefits of better cosmesis, less pain, shorter length of stay in the hospital and earlier recovery from the operation.
In Duodenum-Preserving Pancreatic Head Resection (DPPHR), only the head of pancreas is removed, with preservation of the duodenum and the bile duct. The defect in the pancreatic head is then reconstructed by stitching a loop of intestine to the pancreas. It is believed that pain originates from the head of pancreas. With this procedure, adequate pain relief for chronic pancreatitis patients is expected in majority of the patients.
Whipple operation may be necessary for some patients, especially those with distal bile duct stenosis where malignancy cannot be excluded.
In pancreatic operations, whether it involves removing part of the pancreas or joining the pancreas to the small bowel, the risk of pancreatic fistula is always a concern. Pancreatic fistula is a complication due to the leakage of pancreatic juice into the belly causing infection and inflammation. The other concern is the recurrence of pain after the operation.