Local resection of the pancreatitic head for pancreatic pseudocysts.

BACKGROUND: Local resection of the head (LRPH) has improved markedly the clinical outcome of patients that undergo surgery for chronic pancreatitis. LRPH is often combined with a lateral pancreatojejunostomy for complete duct drainage. Randomized controlled trials have confirmed the superiority of the Frey and Beger operations compared to pancreatoduodenectomy. Appropriate patient selection is critical to an excellent outcome. Patients with an enlarged pancreatic head or duodenal or biliary obstruction are ideal candidates for LRPH. In addition, patients with symptomatic pseudocysts in the pancreatic head can be adequately treated with these operations. PROCEDURE: The procedure described herein includes a generous pancreatic head resection to ensure pain relief, a pancreatic ductotomy onto the body and tail of the gland for complete drainage, and an intrapancreatic biliary sphincteroplasty for decompression of an obstructed bile duct.
CONCLUSIONS: Perioperative hemorrhage is a potential major complication associated with LRPH. The long-term outcome is an excellent pain relief and improves overall quality of life.