Chronic pancreatitis (CP) is a prolonged inflammation of the pancreas with pain as its severest symptom and every so often impaired quality-of-life. Surgical intervention plays a very significant role in managing pain, but kept as a last opinion, when conservative measures and endoscopy have failed.

In an international working group with 15 experts on CP surgery strong consensus was obtained as follows: Surgery in CP is specified as treatment of stubborn pain. In case of suspicion of malignant (cystic) lesion; timely surgery is preferred to achieve optimal long-term pain relief. In patients with an enlarged pancreatic head, a joint drainage and resection procedure, such as the Frey, Beger, and Berne technique, may be the treatment of choice. For patients with groove pancreatitis, pancreatic oduodenectomy is the most appropriate surgical option.

Patients with genetic CP have high risk of pancreatic cancer that prophylactic resection can be considered (lifetime risk of 40–55%). Weak agreement for procedure choice in patients with dilated duct and normal size pancreatic head: both the extended lateral pancreaticojejunostomy and Frey procedure seems to provide equivalent pain control in patients.

This international expert consensus recommendation conveys evidence-based statements regarding key aspects in surgery and timing of intervention in CP. It is intended to guide clinical practitioners and surgeons in the treatment of patients with CP.

Source: Pancreatology. 2020 Mar;20(2):149-157