Chronic pancreatitis is a inhomogeneous disease of multifactorial genesis and a variable
clinical course. Upper
abdominal pain is the leading clinical symptom of the majority of the patients. The primary treatment of these patients is conservative, but if the treatment fails in
pain relief or organ complications occur surgical treatment is indicated. The most common organ complications due to
chronic pancreatitis are
stenosis of the common bile duct and the pancreatic duct,
duodenal stenosis,
stenosis of the portal vein with
portal hypertension,
pancreatic pseudocysts and the development of
pancreatic fistula. Due to the pathophysiological concept of an elevated duct pressure as a source of
pain, duct
decompression by drainage procedures is the favored
surgical procedure by many surgeons. Nevertheless, even in patients with a dilated pancreatic main duct, only half of the patients will benefit from drainage operations. Long-term severe upper
abdominal pain and complications of the neighboring organs due to an inflammatory mass in the head of the pancreas should be indicative for resective procedures which should be organ-preserving as much as possible and take into account the endocrine function of the pancreatic gland. Simultaneous multiple organ resections like pylorus-preserving partial
duodenopancreatectomy or total
pancreatectomy are not necessary for a benign disease and should be only performed in patients with proven
malignancy. The aim of the
surgical procedure is to reduce
pain and frequency of relapsing
pancreatitis without impairing the endocrine function of the pancreatic gland.