Langenbeck's Archives of Surgery

, Volume 396, Issue 2, pp 139–149 | Cite as

Chronic pancreatitis: modern surgical management

  • Kai Bachmann
  • Jakob R. Izbicki
  • Emre F. Yekebas
Review Article

Abstract

Introduction

Chronic pancreatitis (CP) is a disease with enormous social and personal impact. It is most commonly caused by the abuse of alcohol combined with nicotine. CP is usually characterised by an inflammatory mass located in the pancreatic head. Its natural course is characterised by persistent or recurrent painful attacks as well as progressive loss of pancreatic function due to fibrosis of the parenchyma with consecutive endocrine and exocrine insufficiency.

Conclusions

The only success parameter of any treatment is the effective long-lasting pain relief and improvement in the quality of life. The surgical armamentarium includes simple drainage procedures, resections of different extents or a combination of both. Duodenum-preserving resection of the pancreas offers the best short-term outcome according to trials conducted so far. It has the benefit of combining the highest safety with the highest efficiency. Additionally, the extent of the operation can be adapted to the morphology of the individual patient.

Keywords

Chronic pancreatitis Review Surgery Quality of life Duodenum-preserving resection 

Notes

Conflicts of interest

None.

References

  1. 1.
    Adler DG, Lichtenstein D, Baron TH, Davila R, Egan JV, Gan SL, Qureshi WA, Rajan E, Shen B, Zuckerman MJ, Lee KK, VanGuilder T, Fanelli RD (2006) The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc 63(7):933–937CrossRefPubMedGoogle Scholar
  2. 2.
    Ammann RW (1997) A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas 14:215–221CrossRefPubMedGoogle Scholar
  3. 3.
    Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984) Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical–surgical series of 245 patients. Gastroenterology 86:820–888PubMedGoogle Scholar
  4. 4.
    Ammann RW, Mullhaupt B (2007) Do the diagnostic criteria differ between alcoholic and nonalcoholic chronic pancreatitis? J Gastroenterol 42(Suppl 17):118–126CrossRefPubMedGoogle Scholar
  5. 5.
    Bachmann K, Mann O, Izbicki JR, Strate T (2008) Chronic pancreatitis—a surgeons' view. Med Sci Monit 14(11):RA198–RA205PubMedGoogle Scholar
  6. 6.
    Beger HG, Buechler M (1990) Duodenum preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head. World J Surg 14:83–87CrossRefPubMedGoogle Scholar
  7. 7.
    Beger HG, Witte C, Krautzberger W, Bittner R (1980) Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg 51:303–307PubMedGoogle Scholar
  8. 8.
    Bernades P, Baetz A, Levy P, Belghiti J, Menu Y, Fekete F (1992) Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical–surgical series of 266 patients. Dig Dis Sci 37:340–346CrossRefPubMedGoogle Scholar
  9. 9.
    Bloechle C, Busch C, Tesch C, Nicolas V, Binmoeller KF, Soehendra N, Izbicki JR (1997) Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis. Br J Surg 84:477–482CrossRefPubMedGoogle Scholar
  10. 10.
    Bockhorn M, Gebauer F, Bogoevski D, Molmenti E, Cataldegirmen G, Vashist YK, Yekebas EF, Izbicki JR, Mann O (2010) Chronic pancreatitis complicated by cavernous transformation of the portal vein: contraindication to surgery? Surgery. doi: 10.1016/j.surg.2010.06.011
  11. 11.
    Born P, Rosch T, Bruhl K, Ulm K, Sandschin W, Frimberger E, Allescher H, Classen M (1998) Long-term results of endoscopic treatment of biliary duct obstruction due to pancreatic disease. Hepatogastroenterology 45(21):833–839PubMedGoogle Scholar
  12. 12.
    Bracher GA, Manocha AP, DeBanto JR, Gates LK Jr, Slivka A, Whitcomb DC, Bleau BL, Ulrich CD, Martin SP (1999) Endoscopic pancreatic duct stenting to treat pancreatic ascites. Gastrointest Endosc 49(6):710–715CrossRefPubMedGoogle Scholar
  13. 13.
    Bradley EL (1987) Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg 153:207–213CrossRefPubMedGoogle Scholar
  14. 14.
    Buchler MW, Friess H, Muller MW, Wheatley AM, Beger HG (1995) Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 169(1):65–69CrossRefPubMedGoogle Scholar
  15. 15.
    Buechler M, Friess H, Isenmann R, Bittner R, Beger HG (1993) Duodenum-preserving resection of the head of the pancreas: the Ulm experience. In: Beger HG, Buechler M, Malfertheimer P (eds) Standards in pancreatic surgery. Springer, Berlin, pp 436–449Google Scholar
  16. 16.
    Buechler MW, Friess H, Bittner R, Roscher R, Krautzberger W, Mueller MW, Malfertheiner P, Beger HG (1997) Duodenum-preserving pancreatic head resection: long-term results. J Gastrointest Surg 1:13–19CrossRefGoogle Scholar
  17. 17.
    Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Lameris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ (2007) Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 356(7):676–684CrossRefPubMedGoogle Scholar
  18. 18.
    Cataldegirmen G, Bogoevski D, Mann O, Kaifi JT, Izbicki JR, Yekebas EF (2008) Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity. Br J Surg 95(4):447–452CrossRefPubMedGoogle Scholar
  19. 19.
    Chari ST (2007) Chronic pancreatitis: classification, relationship to acute pancreatitis, and early diagnosis. J Gastroenterol 42(Suppl 17):58–59CrossRefPubMedGoogle Scholar
  20. 20.
    Chebli JM, Gaburri PD, De Souza AF, Ornellas AT, Martins Junior EV, Chebli LA, Felga GE, Pinto JR (2004) Internal pancreatic fistulas: proposal of a management algorithm based on a case series analysis. J Clin Gastroenterol 38(9):795–800CrossRefPubMedGoogle Scholar
  21. 21.
    da Cunha JE, Machado M, Bacchella T, Penteado S, Mott CB, Jukemura J, Pinotti HW (1995) Surgical treatment of pancreatic ascites and pancreatic pleural effusions. Hepatogastroenterology 42(5):748–751PubMedGoogle Scholar
  22. 22.
    Diener MK, Rahbari NN, Fischer L, Antes G, Buchler MW, Seiler CM (2008) Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg 247(6):950–961CrossRefPubMedGoogle Scholar
  23. 23.
    Duffy JP, Delano MJ, Reber HA (2002) Pancreatic surgery. Curr Opin Gastroenterol 18(5):568–573CrossRefPubMedGoogle Scholar
  24. 24.
    Eckhauser F, Raper SE, Knol JA, Mulholland MW (1991) Surgical management of pancreatic pseudocysts, pancreatic ascites, and pancreaticopleural fistulas. Pancreas 6(Suppl 1):S66–S75PubMedGoogle Scholar
  25. 25.
    Farkas G, Leindler L, Daroczi M, Farkas G Jr (2008) Long-term follow-up after organ-preserving pancreatic head resection in patients with chronic pancreatitis. J Gastrointest Surg 12(2):308–312CrossRefPubMedGoogle Scholar
  26. 26.
    Farkas G, Leindler L, Daroczi M, Farkas G Jr (2006) Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy. Langenbecks Arch Surg 391(4):338–342CrossRefPubMedGoogle Scholar
  27. 27.
    Frey CF, Amikura K (1994) Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg 220:492–507CrossRefPubMedGoogle Scholar
  28. 28.
    Frey CF, Smith GJ (1987) Description and rationale of a new operation for chronic pancreatitis. Pancreas 2:701–707CrossRefPubMedGoogle Scholar
  29. 29.
    Frey CF, Suzuki M, Isaji S (1990) Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 14:59–69CrossRefPubMedGoogle Scholar
  30. 30.
    Gloor B, Friess H, Uhl W, Buchler MW (2001) A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 18:21–25CrossRefPubMedGoogle Scholar
  31. 31.
    Gomez-Cerezo J, Barbado CA, Suarez I, Soto A, Rios JJ, Vazquez JJ (2003) Pancreatic ascites: study of therapeutic options by analysis of case reports and case series between the years 1975 and 2000. Am J Gastroenterol 98(3):568–577PubMedGoogle Scholar
  32. 32.
    Howard TJ, Browne JS, Zyromski NJ, Lavu H, Baker MS, Shen C, Madura JA (2008) Mechanisms of primary operative failure and results of remedial operation in patients with chronic pancreatitis. J Gastrointest Surg 12(12):2087–2095CrossRefPubMedGoogle Scholar
  33. 33.
    Huizinga WK, Thomson SR, Spitaels JM, Simjee AE (1992) Chronic pancreatitis with biliary obstruction. Ann R Coll Surg Engl 74(2):119–123PubMedGoogle Scholar
  34. 34.
    Ihse I, Borch K, Larsson J (1990) Chronic pancreatitis: results of operations for relief of pain. World J Surg 14(1):53–58CrossRefPubMedGoogle Scholar
  35. 35.
    Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE (1998) Extended drainage versus resection in surgery for chronic pancreatitis—prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus preserving pancreatoduodenectomy. Ann Surg 228:771–779CrossRefPubMedGoogle Scholar
  36. 36.
    Izbicki JR, Bloechle C, Broering DC, Kuechler T, Broelsch CE (1998) Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis. Ann Surg 227:213–219CrossRefPubMedGoogle Scholar
  37. 37.
    Izbicki JR, Bloechle C, Knoefel WT, Binmoeller KF, Soehendra N, Broelsch CE (1997) Drainage versus Resektion in der chirurgischen Therapie der chronischen Kopfpankreatitis: eine randomisierte Studie. Chirurg 68:369–377CrossRefPubMedGoogle Scholar
  38. 38.
    Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE (1995) Duodenum preserving resections of the head of the pancreas in chronic pancreatitis—a prospective randomized trial. Ann Surg 221:350–358CrossRefPubMedGoogle Scholar
  39. 39.
    Izbicki JR, Bloechle C, Knoefel WT, Rogiers X, Kuechler T (1999) Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am 79:913–944CrossRefPubMedGoogle Scholar
  40. 40.
    Izbicki JR, Bloechle C, Knoefel WT, Wilker DK, Dornschneider G, Seifert H, Passlick B, Rogiers X, Busch C, Broelsch CE (1994) Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas. Br J Surg 81:1351–1355CrossRefPubMedGoogle Scholar
  41. 41.
    Izbicki JR, Wilker DK, Waldner H, Rueff FL, Schweiberer L (1989) Thoracic manifestations of internal pancreatic fistulas: report of five cases. Am J Gastroenterol 84(3):265–271PubMedGoogle Scholar
  42. 42.
    Izbicki JR, Yekebas EF, Strate T, Eisenberger CF, Hosch SB, Steffani K, Knoefel WT (2002) Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited. Ann Surg 236:82–89CrossRefPubMedGoogle Scholar
  43. 43.
    Kahl S, Zimmermann S, Genz I, Glasbrenner B, Pross M, Schulz HU, Mc ND, Schmidt U, Malfertheiner P (2003) Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am J Gastroenterol 98(11):2448–2453CrossRefPubMedGoogle Scholar
  44. 44.
    Kaman L, Behera A, Singh R, Katariya RN (2001) Internal pancreatic fistulas with pancreatic ascites and pancreatic pleural effusions: recognition and management. ANZ J Surg 71(4):221–225CrossRefPubMedGoogle Scholar
  45. 45.
    Klempa I, Spatny M, Menzel J, Baca I, Nustede R, Stoeckmann F, Arnold W (1995) Pankreasfunktion und Lebensqualität nach Pankreaskopfresektion bei der chronischen Pankreatitis. Chirurg 66:350–359PubMedGoogle Scholar
  46. 46.
    Kloppel G, Maillet B (1993) Pathology of acute and chronic pancreatitis. Pancreas 8(6):659–670CrossRefPubMedGoogle Scholar
  47. 47.
    Kloppel G, Maillet B (1992) The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis. Virchows Arch A Pathol Anat Histopathol 420(1):1–4CrossRefPubMedGoogle Scholar
  48. 48.
    Knoefel WT, Eisenberger CF, Strate T, Izbicki JR (2002) Optimizing surgical therapy for chronic pancreatitis. Pancreatology 2:379–385CrossRefPubMedGoogle Scholar
  49. 49.
    Koninger J, Seiler CM, Sauerland S, Wente MN, Reidel MA, Muller MW, Friess H, Buchler MW (2008) Duodenum-preserving pancreatic head resection—a randomized controlled trial comparing the original Beger procedure with the Berne modification (ISRCTN No. 50638764). Surgery 143(4):490–498CrossRefPubMedGoogle Scholar
  50. 50.
    Kozarek RA, Ball TJ, Patterson DJ, Raltz SL, Traverso LW, Ryan JA, Thirlby RC (1997) Transpapillary stenting for pancreaticocutaneous fistulas. J Gastrointest Surg 1(4):357–361CrossRefPubMedGoogle Scholar
  51. 51.
    Kutup A, Vashist Y, Kaifi JT, Yekebas EF, Izbicki JR (2010) For which type of chronic pancreatitis is the "Hamburg procedure" indicated? J Hepatobiliary Pancreat Sci 17(6):758–762CrossRefPubMedGoogle Scholar
  52. 52.
    Lankisch PG, Andren-Sandberg A (1993) Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment. Int J Pancreatol 14:205–212PubMedGoogle Scholar
  53. 53.
    Lankisch PG, Happe-Loehr A, Otto J, Creutzfeldt W (1993) Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digest 54:148–155CrossRefGoogle Scholar
  54. 54.
    Lipsett PA, Cameron JL (1992) Internal pancreatic fistula. Am J Surg 163(2):216–220CrossRefPubMedGoogle Scholar
  55. 55.
    Little AG, Moossa AR (1981) Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis. Am J Surg 141(1):153–158CrossRefPubMedGoogle Scholar
  56. 56.
    Malka D, Hammel P, Levy P, Sauvanet A, Ruszniewski P, Belghiti J, Bernades P (1998) Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical–surgical series of 500 patients. Br J Surg 85(12):1645–1649CrossRefPubMedGoogle Scholar
  57. 57.
    Malka D, Hammel P, Sauvanet A, Rufat P, O'Toole D, Bardet P, Belghiti J, Bernades P, Ruszniewski P, Levy P (2000) Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 119:1324–1332CrossRefPubMedGoogle Scholar
  58. 58.
    Markowitz JS, Rattner DW, Warshaw AL (1994) Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis. Strategies for salvage. Arch Surg 129:374–379PubMedGoogle Scholar
  59. 59.
    Mayerle J, Lerch MM (2007) Is it necessary to distinguish between alcoholic and nonalcoholic chronic pancreatitis? J Gastroenterol 42(Suppl 17):127–130CrossRefPubMedGoogle Scholar
  60. 60.
    Mobius C, Max D, Uhlmann D, Gumpp K, Behrbohm J, Horvath K, Hauss J, Witzigmann H (2007) Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis. Langenbecks Arch Surg 392(3):359–364CrossRefPubMedGoogle Scholar
  61. 61.
    Muller MW, Friess H, Martin DJ, Hinz U, Dahmen R, Buchler MW (2008) Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg 95(3):350–356CrossRefPubMedGoogle Scholar
  62. 62.
    Nealon WH, Thompson JC (1993) Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. Ann Surg 217:458–468CrossRefPubMedGoogle Scholar
  63. 63.
    Oktedalen O, Nygaard K, Osnes M (1990) Somatostatin in the treatment of pancreatic ascites. Gastroenterology 99(5):1520–1521PubMedGoogle Scholar
  64. 64.
    Partington PF, Rochelle REL (1960) Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 152:1037–1043CrossRefPubMedGoogle Scholar
  65. 65.
    Pessaux P, Kianmanesh R, Regimbeau JM, Sastre B, Delcenserie R, Sielezneff I, Arnaud JP, Sauvanet A (2006) Frey procedure in the treatment of chronic pancreatitis: short-term results. Pancreas 33(4):354–358CrossRefPubMedGoogle Scholar
  66. 66.
    Prinz RA, Aranha GV, Greenlee HB (1985) Combined pancreatic duct and upper gastrointestinal and biliary tract drainage in chronic pancreatitis. Arch Surg 120(3):361–366PubMedGoogle Scholar
  67. 67.
    Runyon BA (1987) Amylase levels in ascitic fluid. J Clin Gastroenterol 9(2):172–174CrossRefPubMedGoogle Scholar
  68. 68.
    Ryder NM, Reber HA (2000) Pancreatic surgery. Curr Opin Gastroenterol 16(5):426–430CrossRefPubMedGoogle Scholar
  69. 69.
    Saeger HD, Schwall G, Trede M (1993) Standard Whipple in chronic pancreatitis. In: Beger HG, Buechler M, Malfertheimer P (eds) Standards in pancreatic surgery. Springer, Berlin, pp 385–391Google Scholar
  70. 70.
    Saps M, Slivka A, Khan S, Meza MP, Goyal A, Di LC (2003) Pancreatic ascites in an infant: lack of symptoms and normal amylase. Dig Dis Sci 48(9):1701–1704CrossRefPubMedGoogle Scholar
  71. 71.
    Schnelldorfer T, Lewin DN, Adams DB (2006) Reoperative surgery for chronic pancreatitis: is it safe? World J Surg 30(7):1321–1328CrossRefPubMedGoogle Scholar
  72. 72.
    Seelig MH, Chromik AM, Weyhe D, Muller CA, Belyaev O, Mittelkotter U, Tannapfel A, Uhl W (2007) Pancreatic redo procedures: to do or not to do—this is the question. J Gastrointest Surg 11(9):1175–1182CrossRefPubMedGoogle Scholar
  73. 73.
    Seelig MH, Janot M, Chromik AM, Herzog T, Belyaev O, Weyhe D, Meurer K, Meiser A, Tannapfel A, Uhl W (2009) Redo-surgery following curative resection of pancreatic carcinoma: the difference between true and suspected recurrence. Dig Surg 26(3):222–228CrossRefPubMedGoogle Scholar
  74. 74.
    Soto JA, Barish MA, Yucel EK, Clarke P, Siegenberg D, Chuttani R, Ferrucci JT (1995) Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique. Radiology 196(2):459–464PubMedGoogle Scholar
  75. 75.
    Steer ML, Waxman I, Freedman S (1995) Chronic pancreatitis. N Engl J Med 332(22):1482–1490CrossRefPubMedGoogle Scholar
  76. 76.
    Stenger AM, Knoefel WT, Dahmen U, Blochle C, Izbicki JR (1998) Pancreatico-bronchial fistula with communication to a pseudoaneurysm of the arteria lienalis as a rare complication in chronic pancreatitis. Z Gastroenterol 36(12):1047–1051PubMedGoogle Scholar
  77. 77.
    Strate T, Bachmann K, Busch P, Mann O, Schneider C, Bruhn JP, Yekebas E, Kuechler T, Bloechle C, Izbicki JR (2008) Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 134(5):1406–1411CrossRefPubMedGoogle Scholar
  78. 78.
    Strate T, Knoefel WT, Yekebas E, Izbicki JR (2003) Chronic pancreatitis: etiology, pathogenesis, diagnosis, and treatment. Int J Colorectal Dis 18(2):97–106PubMedGoogle Scholar
  79. 79.
    Strate T, Taherpour Z, Bloechle C, Mann O, Bruhn JP, Schneider C, Kuechler T, Yekebas E, Izbicki JR (2005) Long-term follow-up of a randomized trial comparing the Beger and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg 241(4):591–598CrossRefPubMedGoogle Scholar
  80. 80.
    Strate T, Yekebas E, Knoefel WT, Bloechle C, Izbicki JR (2002) Pathogenesis and the natural course of chronic pancreatitis. Eur J Gastroenterol Hepatol 14:929–934CrossRefPubMedGoogle Scholar
  81. 81.
    Traverso LW, Tompkins RK, Urrea PT, Longmire WP Jr (1979) Surgical treatment of chronic pancreatitis. Twenty-two years' experience. Ann Surg 190(3):312–319CrossRefPubMedGoogle Scholar
  82. 82.
    Uchiyama T, Yamamoto T, Mizuta E, Suzuki T (1989) Pancreatic ascites—a collected review of 37 cases in Japan. Hepatogastroenterology 36(4):244–248PubMedGoogle Scholar
  83. 83.
    Uhl W, Buchler MW, Malfertheiner P, Beger HG, Adler G, Gaus W (1999) A randomised, double blind, multicenter trial of octreotide in moderate to severe acute pancreatitis. Gut 45:97–104CrossRefPubMedGoogle Scholar
  84. 84.
    Vijungco JD, Prinz RA (2003) Management of biliary and duodenal complications of chronic pancreatitis. World J Surg 27(11):1258–1270CrossRefPubMedGoogle Scholar
  85. 85.
    Warshaw AL (1984) Pain in chronic pancreatitis—patients, patience, and the impatient surgeon. Gastroenterology 86:987–989PubMedGoogle Scholar
  86. 86.
    Warshaw AL, Jin GL, Ottinger LW (1987) Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis. Arch Surg 122:410–445PubMedGoogle Scholar
  87. 87.
    Warshaw AL, Rattner DW (1985) Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria. Ann Surg 202(6):720–724CrossRefPubMedGoogle Scholar
  88. 88.
    Wislooff F, Jakobsen J, Osnes M (1982) Stenosis of the common bile duct in chronic pancreatitis. Br J Surg 69(1):52–54CrossRefPubMedGoogle Scholar
  89. 89.
    Yekebas EF, Bogoevski D, Honarpisheh H, Cataldegirmen G, Habermann CR, Seewald S, Link BC, Kaifi JT, Wolfram L, Mann O, Bubenheim M, Izbicki JR (2006) Long-term follow-up in small duct chronic pancreatitis: a plea for extended drainage by "V-shaped excision" of the anterior aspect of the pancreas. Ann Surg 244(6):940–946CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Kai Bachmann
    • 1
  • Jakob R. Izbicki
    • 1
  • Emre F. Yekebas
    • 1
  1. 1.Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg–EppendorfHamburgGermany

Personalised recommendations