Skip to main content

Advertisement

SpringerLink
Log in

Surgical Management of Chronic Pancreatitis

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Muniraj T, Aslanian HR, Farrell J, Jamidar PA (2014) Chronic pancreatitis, a comprehensive review and update. Part I: epidemiology, etiology, risk factors, genetics, pathophysiology, and clinical features. Dis Mon 60(12):530–550

    Article  PubMed  Google Scholar 

  2. Balakrishnan V, Unnikrishnan AG, Thomas V et al (2008) Chronic pancreatitis. A prospective nationwide study of 1,086 subjects from India. JOP 9(5):593–600

    PubMed  Google Scholar 

  3. Brock C, Nielsen LM, Lelic D, Drewes AM (2013) Pathophysiology of chronic pancreatitis. World J Gastroenterol 19(42):7231–7240

    Article  PubMed  PubMed Central  Google Scholar 

  4. Whitcomb DC (2010) Genetic aspects of pancreatitis. Annu Rev Med 61:413–424

    Article  PubMed  CAS  Google Scholar 

  5. Whitcomb DC (2013) Genetic risk factors for pancreatic disorders. Gastroenterology 144(6):1292–1302

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Apte MV, Haber PS, Darby SJ et al (1999) Pancreatic stellate cells are activated by proinflammatory cytokines: implications for pancreatic fibrogenesis. Gut 44(4):534–541

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Lee YA, Wallace MC, Friedman SL (2015) Pathobiology of liver fibrosis: a translational success story. Gut 64(5):830–841

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120(3):682–707

    Article  PubMed  CAS  Google Scholar 

  9. Cote GA, Yadav D, Slivka A et al (2011) Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clin Gastroenterol Hepatol 9(3):266–273, quiz e27

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mullady DK, Yadav D, Amann ST et al (2011) Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Gut 60(1):77–84

    Article  PubMed  Google Scholar 

  11. Yadav D, Whitcomb DC (2010) The role of alcohol and smoking in pancreatitis. Nat Rev Gastroenterol Hepatol 7(3):131–145

    Article  PubMed  Google Scholar 

  12. Schneider A, Löhr JM, Singer MV (2007) The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 42:101–119

    Article  PubMed  Google Scholar 

  13. Dufour MC, Adamson MD (2003) The epidemiology of alcohol-induced pancreatitis. Pancreas 27(4):286–290

    Article  PubMed  Google Scholar 

  14. Whitcomb DC (2012) Genetics of alcoholic and nonalcoholic pancreatitis. Curr Opin Gastroenterol 28(5):501–506

    Article  PubMed  Google Scholar 

  15. Maisonneuve P, Lowenfels AB, Müllhaupt B et al (2005) Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut 54(4):510–514

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Rebours V, Vullierme MP, Hentic O et al (2012) Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship. Pancreas 41(8):1219–1224

    Article  PubMed  CAS  Google Scholar 

  17. Imoto M, DiMagno EP (2000) Cigarette smoking increases the risk of pancreatic calcification in late-onset but not early-onset idiopathic chronic pancreatitis. Pancreas 21(2):115–119

    Article  PubMed  CAS  Google Scholar 

  18. Comfort MW, Steinberg AG (1952) Pedigree of a family with hereditary chronic relapsing pancreatitis. Gastroenterology 21(1):54–63

    PubMed  CAS  Google Scholar 

  19. Whitcomb DC, Preston RA, Aston CE et al (1996) A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 110(6):1975–1980

    Article  PubMed  CAS  Google Scholar 

  20. Midha S, Khajuria R, Shastri S, Kabra M, Garg PK (2010) Idiopathic chronic pancreatitis in India: phenotypic characterisation and strong genetic susceptibility due to SPINK1 and CFTR gene mutations. Gut 59(6):800–807

    Article  PubMed  CAS  Google Scholar 

  21. Chen JM, Ferec C (2009) Chronic pancreatitis: genetics and pathogenesis. Annu Rev Genomics Hum Genet 10:63–87

    Article  PubMed  CAS  Google Scholar 

  22. Tamura R, Ishibashi T, Takahashi S (2006) Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation. Radiology 238(3):920–928

    Article  PubMed  Google Scholar 

  23. Catalano MF, Sahai A, Levy M et al (2009) EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 69(7):1251–1261

    Article  PubMed  Google Scholar 

  24. Balci NC, Smith A, Momtahen AJ et al (2010) MRI and S-MRCP findings in patients with suspected chronic pancreatitis: correlation with endoscopic pancreatic function testing (ePFT). J Magn Reson Imaging 31(3):601–606

    Article  PubMed  Google Scholar 

  25. Săftoiu A, Vilmann P, Gorunescu F et al (2011) Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy 43(7):596–603

    Article  PubMed  Google Scholar 

  26. Zuccaro P, Stevens T, Repas K et al (2009) Magnetic resonance cholangiopancreatography reports in the evaluation of chronic pancreatitis: a need for quality improvement. Pancreatology 9(6):764–769

    Article  PubMed  Google Scholar 

  27. Nealon WH, Thompson JC (1993) Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified Puestow procedure. Ann Surg 217(5):458–466, discussion 466–8

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Manes G, Büchler M, Pieramico O, Di Sebastiano P, Malfertheiner P (1994) Is increased pancreatic pressure related to pain in chronic pancreatitis? Int J Pancreatol 15(2):113–117

    PubMed  CAS  Google Scholar 

  29. Ugljesić M, Bulajić M, Milosavljević T, Stimec B (1996) Endoscopic manometry of the sphincter of Oddi and pancreatic duct in patients with chronic pancreatitis. Int J Pancreatol 19(3):191–195

    PubMed  Google Scholar 

  30. Poulsen JL, Olesen SS, Malver LP, Frøkjær JB, Drewes AM (2013) Pain and chronic pancreatitis: a complex interplay of multiple mechanisms. World J Gastroenterol 19(42):7282–7291

    Article  PubMed  PubMed Central  Google Scholar 

  31. White TT, Bourde J (1970) A new observation on human intraductal pancreatic pressure. Surg Gynecol Obstet 130(2):275–278

    PubMed  CAS  Google Scholar 

  32. Fasanella KE, Davis B, Lyons J et al (2007) Pain in chronic pancreatitis and pancreatic cancer. Gastroenterol Clin N Am 36(2):335–364, ix

    Article  Google Scholar 

  33. Demir IE, Tieftrunk E, Maak M, Friess H, Ceyhan GO (2011) Pain mechanisms in chronic pancreatitis: of a master and his fire. Langenbecks Arch Surg 396(2):151–160

    Article  PubMed  PubMed Central  Google Scholar 

  34. D’Haese JG, Ceyhan GO, Demir IE, Tieftrunk E, Friess H (2014) Treatment options in painful chronic pancreatitis: a systematic review. HPB (Oxford) 16(6):512–521

    Article  Google Scholar 

  35. Bockman DE, Buchler M, Malfertheiner P, Beger HG (1988) Analysis of nerves in chronic pancreatitis. Gastroenterology 94(6):1459–1469

    PubMed  CAS  Google Scholar 

  36. Ceyhan GO, Bergmann F, Kadihasanoglu M et al (2009) Pancreatic neuropathy and neuropathic pain—a comprehensive pathomorphological study of 546 cases. Gastroenterology 136(1):177–186, e1

    Article  PubMed  Google Scholar 

  37. Ceyhan GO, Demir IE, Rauch U et al (2009) Pancreatic neuropathy results in “neural remodeling” and altered pancreatic innervation in chronic pancreatitis and pancreatic cancer. Am J Gastroenterol 104(10):2555–2565

    Article  PubMed  Google Scholar 

  38. Demir I, Tieftrunk E, Maak M, Friess H, Ceyhan GO (2011) Pain mechanisms in chronic pancreatitis: of a master and his fire. Langenbeck’s Arch Surg 396(2):151–160

    Article  Google Scholar 

  39. Olesen SS, Frøkjær JB, Lelic D, Valeriani M, Drewes AM (2010) Pain-associated adaptive cortical reorganisation in chronic pancreatitis. Pancreatology 10(6):742–751

    Article  PubMed  Google Scholar 

  40. Frokjaer JB, Andersen LW, Brock C et al (2013) Altered brain microstructure assessed by diffusion tensor imaging in patients with diabetes and gastrointestinal symptoms. Diabetes Care 36(3):662–668

    Article  PubMed  PubMed Central  Google Scholar 

  41. Olesen SS, Juel J, Graversen C et al (2013) Pharmacological pain management in chronic pancreatitis. World J Gastroenterol 19(42):7292–7301

    Article  PubMed  PubMed Central  Google Scholar 

  42. Muniraj T, Aslanian HR, Farrell J, Jamidar PA (2015) Chronic pancreatitis, a comprehensive review and update. Part II: diagnosis, complications, and management. Dis Mon 61(1):5–37

    Article  PubMed  Google Scholar 

  43. Issa Y, van Santvoort HC, van Goor H et al (2013) Surgical and endoscopic treatment of pain in chronic pancreatitis: a multidisciplinary update. Dig Surg 30(1):35–50

    Article  PubMed  CAS  Google Scholar 

  44. Dumonceau JM, Delhaye M, Tringali A et al (2012) Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 44(8):784–800

    Article  PubMed  Google Scholar 

  45. Díte P, Ruzicka M, Zboril V, Novotný I (2003) A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 35(7):553–558

    Article  PubMed  Google Scholar 

  46. Cahen DL, Gouma DJ, Laramée P et al (2011) Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 141(5):1690–1695

    Article  PubMed  Google Scholar 

  47. Ahmed Ali U, Issa Y, Bruno MJ et al (2013) Early surgery versus optimal current step-up practice for chronic pancreatitis (ESCAPE): design and rationale of a randomized trial. BMC Gastroenterol 13:49

    Article  PubMed  PubMed Central  Google Scholar 

  48. Puestow CB, Gillesby WJ (1958) Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 76(6):898–907

    Article  PubMed  CAS  Google Scholar 

  49. Partington PF, Rochelle RE (1960) Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 152:1037–1043

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  50. Frey CF, Smith GJ (1987) Description and rationale of a new operation for chronic pancreatitis. Pancreas 2(6):701–707

    Article  PubMed  CAS  Google Scholar 

  51. Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J (1985) Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 97(4):467–473

    PubMed  CAS  Google Scholar 

  52. Sutherland DE, Radosevich DM, Bellin MD et al (2012) Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg 214(4):409–424, discussion 424–6

    Article  PubMed  PubMed Central  Google Scholar 

  53. Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH et al (2012) Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg 147(10):925–932

    PubMed  Google Scholar 

  54. O’Neil SJ, Aranha GV (2003) Lateral pancreaticojejunostomy for chronic pancreatitis. World J Surg 27(11):1196–1202

    Article  PubMed  Google Scholar 

  55. Prinz RA, Greenlee HB (1981) Pancreatic duct drainage in 100 patients with chronic pancreatitis. Ann Surg 194(3):313–320

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  56. Izbicki JR, Bloechle C, Knoefel WT, Rogiers X, Kuechler T (1999) Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin N Am 79(4):913–944

    Article  PubMed  CAS  Google Scholar 

  57. Bachmann K, Tomkoetter L, Erbes J et al (2014) Beger and Frey procedures for treatment of chronic pancreatitis: comparison of outcomes at 16-year follow-up. J Am Coll Surg 219(2):208–216

    Article  PubMed  Google Scholar 

  58. Negi S, Singh A, Chaudhary A (2010) Pain relief after Frey’s procedure for chronic pancreatitis. Br J Surg 97(7):1087–1095

    Article  PubMed  CAS  Google Scholar 

  59. Roch A, Teyssedou J, Mutter D, Marescaux J, Pessaux P (2014) Chronic pancreatitis: a surgical disease? Role of the Frey procedure. World J Gastrointest Surg 6(7):129–135

    Article  PubMed  PubMed Central  Google Scholar 

  60. Strate T, Bachmann K, Busch P et al (2008) Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 134(5):1406–1411

    Article  PubMed  Google Scholar 

  61. Strate T, Taherpour Z, Bloechle C et al (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):591–598

    Article  PubMed  PubMed Central  Google Scholar 

  62. Yin Z, Sun J, Yin D, Wang J (2012) Surgical treatment strategies in chronic pancreatitis: a meta-analysis. Arch Surg 147(10):961–968

    Article  PubMed  Google Scholar 

  63. Gestic MA, Callejas-Neto F, Chaim EA et al (2011) Surgical treatment of chronic pancreatitis using Frey’s procedure: a Brazilian 16-year single-centre experience. HPB (Oxford) 13(4):263–271

    Article  Google Scholar 

  64. Falconi M, Bassi C, Casetti L et al (2006) Long-term results of Frey’s procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 10(4):504–510

    Article  PubMed  Google Scholar 

  65. 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(4):492–504, discussion 504–7

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  66. Izbicki JR, Bloechle C, Broering DC et al (1998) Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg 228(6):771–779

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  67. Farkas G, Leindler L, Daróczi M, Farkas G Jr (2006) Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy. Langenbecks Arch Surg 391(4):338–342

    Article  PubMed  Google Scholar 

  68. Buchler MW, Friess H, Müller 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):65–69, discussion 69–70

    Article  PubMed  CAS  Google Scholar 

  69. Izbicki JR, Bloechle C, Knoefel WT et al (1997) Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study. Chirurg 68(4):369–377

    Article  PubMed  CAS  Google Scholar 

  70. Sutherland DE, Matas AJ, Najarian JS (1978) Pancreatic islet cell transplantation. Surg Clin N Am 58(2):365–382

    PubMed  CAS  Google Scholar 

  71. Bellin MD, Freeman ML, Gelrud A et al (2014) Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 14(1):27–35

    Article  PubMed  PubMed Central  Google Scholar 

  72. Bellin MD, Gelrud A, Arreaza-Rubin G et al (2015) Total pancreatectomy with islet autotransplantation: summary of an NIDDK workshop. Ann Surg 261(1):21–29

    Article  PubMed  Google Scholar 

  73. Wilson GC, Sutton JM, Abbott DE et al (2014) Long-term outcomes after total pancreatectomy and islet cell autotransplantation: is it a durable operation? Ann Surg 260(4):659–665, discussion 665–7

    Article  PubMed  Google Scholar 

  74. Wilson GC, Sutton JM, Smith MT et al. (2015) Completion pancreatectomy and islet cell autotransplantation as salvage therapy for patients failing previous operative interventions for chronic pancreatitis. Surgery

  75. Witkowski P, Savari O, Matthews JB (2014) Islet autotransplantation and total pancreatectomy. Adv Surg 48:223–233

    Article  PubMed  PubMed Central  Google Scholar 

  76. Kesseli SJ, Smith KA, Gardner TB (2015) Total pancreatectomy with islet autologous transplantation: the cure for chronic pancreatitis? Clin Transl Gastroenterol 6:e73

    Article  PubMed  PubMed Central  Google Scholar 

  77. Farney AC, Najarian JS, Nakhleh RE et al (1991) Autotransplantation of dispersed pancreatic islet tissue combined with total or near-total pancreatectomy for treatment of chronic pancreatitis. Surgery 110(2):427–437, discussion 437–9

    PubMed  CAS  Google Scholar 

  78. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L (2011) A comprehensive review of opioid-induced hyperalgesia. Pain Physician 14(2):145–161

    PubMed  Google Scholar 

  79. Terrace JD, Paterson HM, Garden OJ, Parks RW, Madhavan KK (2007) Results of decompression surgery for pain in chronic pancreatitis. HPB (Oxford) 9(4):308–311

    Article  CAS  Google Scholar 

  80. van der Gaag NA, van Gulik TM, Busch OR et al (2012) Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis. Ann Surg 255(4):763–770

    Article  PubMed  Google Scholar 

  81. Yang CJ, Bliss LA, Schapira EF et al (2014) Systematic review of early surgery for chronic pancreatitis: impact on pain, pancreatic function, and re-intervention. J Gastrointest Surg 18(10):1863–1869

    Article  PubMed  Google Scholar 

  82. Kurian MS, Gagner M (1999) Laparoscopic side-to-side pancreaticojejunostomy (Partington-Rochelle) for chronic pancreatitis. J Hepatobiliary Pancreat Surg 6(4):382–386

    Article  PubMed  CAS  Google Scholar 

  83. Tantia O, Jindal MK, Khanna S, Sen B (2004) Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases. Surg Endosc 18(7):1054–1057

    Article  PubMed  CAS  Google Scholar 

  84. Palanivelu C, Shetty R, Jani K et al (2006) Laparoscopic lateral pancreaticojejunostomy: a new remedy for an old ailment. Surg Endosc 20(3):458–461

    Article  PubMed  CAS  Google Scholar 

  85. Khaled YS, Ammori BJ (2014) Laparoscopic lateral pancreaticojejunostomy and laparoscopic Berne modification of Beger procedure for the treatment of chronic pancreatitis: the first UK experience. Surg Laparosc Endosc Percutan Tech 24(5):e178–e182

    Article  PubMed  Google Scholar 

  86. Parekh D, Berrera K (2010) Laparoscopic assisted duodenum-preserving pancreatic head resection and total pancreatectomy: description of the technique and indications. In ACS multimedia atlas of surgery: pancreas surgery volume, A. Asbun, Fuchshuber, P.R., Editor., American College of Surgeons

  87. Nadkarni NA, Khanna S, Vege SS (2013) Splanchnic venous thrombosis and pancreatitis. Pancreas 42(6):924–931

    Article  PubMed  CAS  Google Scholar 

  88. Butler JR, Eckert GJ, Zyromski NJ et al (2011) Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford) 13(12):839–845

    Article  Google Scholar 

  89. Rebours V, Boudaoud L, Vullierme MP et al (2012) Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia. Am J Gastroenterol 107(10):1579–1585

    Article  PubMed  CAS  Google Scholar 

  90. Bernades P, Baetz A, Lévy P et al (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(3):340–346

    Article  PubMed  CAS  Google Scholar 

  91. Hart PA, Zen Y, Chari ST (2015) Recent advances in autoimmune pancreatitis. Gastroenterology 149(1):39–51

    Article  PubMed  CAS  Google Scholar 

  92. Saluja SS, Kalayarasan R, Mishra PK et al (2014) Chronic pancreatitis with benign biliary obstruction: management issues. World J Surg 38(9):2455–2459

    Article  PubMed  Google Scholar 

  93. Regimbeau JM, Fuks D, Bartoli E et al (2012) A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis. Surg Endosc 26(10):2902–2908

    Article  PubMed  Google Scholar 

  94. Kohan G, Ocampo CG, Zandalazini HI et al (2015) Laparoscopic hepaticojejunostomy and gastrojejunostomy for palliative treatment of pancreatic head cancer in 48 patients. Surg Endosc 29(7):1970–1975

    Article  PubMed  Google Scholar 

  95. Cannon JW, Callery MP, Vollmer CM Jr (2009) Diagnosis and management of pancreatic pseudocysts: what is the evidence? J Am Coll Surg 209(3):385–393

    Article  PubMed  Google Scholar 

  96. Aghdassi A, Mayerle J, Kraft M et al (2008) Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas 36(2):105–112

    Article  PubMed  Google Scholar 

  97. Dumonceau JM, Macias-Gomez C (2013) Endoscopic management of complications of chronic pancreatitis. World J Gastroenterol 19(42):7308–7315

    Article  PubMed  PubMed Central  Google Scholar 

  98. Zerem E, Hauser G, Loga-Zec S et al (2015) Minimally invasive treatment of pancreatic pseudocysts. World J Gastroenterol 21(22):6850–6860

    PubMed  PubMed Central  Google Scholar 

  99. Gumaste VV, Aron J (2010) Pseudocyst management: endoscopic drainage and other emerging techniques. J Clin Gastroenterol 44(5):326–331

    PubMed  Google Scholar 

  100. Nakeeb A (2009) Laparoscopic pancreatic resections. Adv Surg 43:91–102

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA, 90033, USA

    Dilip Parekh & Sathima Natarajan

  2. Department of Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Sathima Natarajan

Authors
  1. Dilip Parekh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sathima Natarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dilip Parekh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parekh, D., Natarajan, S. Surgical Management of Chronic Pancreatitis. Indian J Surg 77, 453–469 (2015). https://doi.org/10.1007/s12262-015-1362-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-015-1362-0

Keywords

Search

Navigation