New perspectives in the surgical management of chronic pancreatitis.

Although the etiology of pain in chronic pancreatitis remains uncertain, that symptom remains the most common indication for surgery in these patients. Current endoscopic and imaging techniques now permit accurate definition of the morphology of the disease. Thus, surgical intervention can be more selectively applied to address specific abnormalities. Pancreaticojejunostomy should be the first line of surgical therapy if the ductal system is dilated. When, in addition, the head of the pancreas is enlarged and inflamed, the operation should include a localized resection of the head, preserving the stomach and duodenum. If the duct is not dilated, some form of pancreatic resection is indicated. The resection should be limited to the most severely diseased part of the pancreas. Efforts should be made to preserve as much pancreatic tissue as possible, while maintaining normal gastrointestinal continuity. In this way, the nutritional and metabolic consequences of pancreatic resection will be minimized.