Preservation of the Duodenum in Total Pancreatectomy for Chronic Pancreatitis

Abstract

To date the role of surgery in the management of chronic pancreatitis is debatable [1]. Undoubtedly, a conservative treatment is preferable for the primary management, and surgery should be reserved for the complications of chronic pancreatitis. Unfortunately, the clinical problem is that of a patient with severe pain, often on an increasing dose of analgesics and whose life quality is destroyed by the effects of both pain and analgesics. There is a group of patients who fail to respond or who relapse after nonsurgical procedures, such as, nerve blocks or endoscopic sphincterotomies; among these there are some whose clinical features are not helped by subtotal pancreatectomy or a drainage procedure. In the patient with pancreatic pain which has not responded to other surgical measures, including resection, the question of total pancreatectomy arises. In fact, for the failures of partial pancreatectomy, there is little more to offer the patient than ablation of the pancreas.