Surgical Management of Chronic Pancreatitis: A Systemic Review

Abstract

Chronic pancreatitis is a debilitating disease. It is caused by the progressive destruction of normal pancreatic parenchyma, which is replaced by fibrous tissue causing pain in addition to pancreatic insufficiency. There is no single mechanism of pain in chronic pancreatitis. Several medical, endoscopic, and surgical treatment strategies are available to control this disease. Surgical techniques are divided into resection, drainage, and hybrid procedures. The review aimed to compare various surgical procedures used in the management of chronic pancreatitis. The ideal operation is the one that effectively and persistently relieves the pain and has the least morbidity with favorable pancreatic reserve. All the randomized control trials from inception to January 2023, which fulfilled the inclusion criteria, were extensively searched on PubMed and a systemic review was conducted comparing the surgical outcomes of the variety of operations used in chronic pancreatitis. Duodenum-preserving pancreatic head resection is the common procedure done with favorable outcomes.

Exocrine pancreatic insufficiency and fat malabsorption related to pancreatectomy and other gastrointestinal surgery: A narrative review

“…For distal duct lesions in which a distal pancreatectomy is performed, the incidence of EPI is in the order of 20%–50%; for a pancreaticoduodenectomy, it is 50%–100%; and for total pancreatectomy, it is 100% 5,6 . In addition to the above, there are a number of procedures performed in chronic pancreatitis that involve resection of a significant volume of pancreatic tissue notably the Frey, Berne, and Beger procedures 7 …”

“…5,6 In addition to the above, there are a number of procedures performed in chronic pancreatitis that involve resection of a significant volume of pancreatic tissue notably the Frey, Berne, and Beger procedures. 7…”

Non-pharmacological pain palliation methods in chronic pancreatitis

“…Because of the high prevalence of recurring pain, drainage treatments have historically been supplanted by resection and hybrid procedures. PD, especially pylorus-preserving PD, and DPPHR are now the most often performed procedures in the treatment of CP[ 4 ]. Both are quite effective in relieving pain and maintaining pancreatic endocrine function.…”

“…A consistent alcohol intake of 70 g or more per day for at least 12 mo is usually necessary to develop CP. Tobacco use is both a risk factor and an independent risk factor for CP[ 3 , 4 ].…”

“…Initially, these alterations largely impair exocrine function, resulting in symptoms such as steatorrhea, weight loss, maldigestion, and vitamin deficiencies. Endocrine failure may occur later in the disease's course, resulting in symptoms and problems associated with diabetes mellitus[ 2 , 4 ].…”