Surgery Options for Chronic Pancreatitis

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Surgery Options for Chronic Pancreatitis

Question:

What is involved in surgery for chronic pancreatitis?

Answer:

Surgery for chronic pancreatitis is generally the last resort for people with prolonged and debilitating pain that cannot be controlled. These people have usually first tried dietary restriction and alcohol avoidance, a trial of pancreatic enzyme replacement and high doses of narcotic pain relievers.

When these options fail, and surgery is considered, two points are worth making. The first is that even the best surgeons can only bring about pain relief (lasting longer than two years) about 60% of the time. The second is that surgery is serious. The pancreas is a delicate and difficult to reach organ. It is highly vulnerable to complications. So a highly skilled and experienced surgeon is a must.

Surgery to treat pancreatitis falls into several categories:

Remove part of the pancreas Surgeons can remove a badly damaged part of the pancreas if it is isolated and deemed to be the source of the pain. The remaining pancreas, which is healthier, is attached to a loop of small intestine so that its juices can flow to their proper destination.

Depressurize the pancreas The pancreas can be depressurized. Surgeons unblock the flow of the juices that have been trapped in its main duct. This is only an option when the duct, which runs the entire length of the organ, is widely dilated. The surgeon can then slit the duct lengthwise. This procedure is sometimes called a "filet" maneuver. The surgeon then removes stones and other debris that have accumulated over the years. The duct is then attached to a segment of intestine to assure that the juices can continue to flow out.

Remove the pancreas If the pancreas is diseased throughout, and its main duct is not dilated, the surgeon may perform a Whipple procedure. This is the removal of all (or nearly all) the pancreas. Because the pancreas holds the cells that produce insulin, this operation leads to insulin-requiring diabetes. (To a lesser extent, this is also true of other procedures that remove pancreatic tissue.)

Block the pain This option avoids doing anything to the pancreas. It is designed to block the sensation of pain from reaching the brain. However, success with this approach is quite variable.

Stephen Goldfinger, M.D., is a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

Last updated:	July 20, 2009