To date, there are several operations that can be used to treat severe cases of chronic pancreatitis occurring with persistent severe pain, but in modern surgery, only two are most commonly used:
- Partial, total or subtotal resection of the gland.
- Longitudinal anastomosis of the pancreatic duct with a jejunum loop, with modified mobilization of the Puestow-Gillesby operation.
The disadvantage of these surgical interventions is the fact that none of them can not be called universal.
Choose an operation for chronic pancreatitis, based on indications of the state of the pancreatic parenchyma and the caliber of the gland duct. Anastomosis is used if the diameter of the pancreatic duct is more than 8 mm. Resection as a surgical intervention is used in the case when the expansion of the duct is not detected and pathological processes are localized in small ducts and parenchyma.
Quite often indications for the surgery of chronic pancreatitis are observed in cases if the disease has an alcoholic origin. However, the operations performed in alcoholic chronic pancreatitis do not improve the endocrine or exocrine functions of the pancreas. They do not stop the functional and anatomical changes, but only reduce the pain in the waist and abdomen. The condition of the gland will continue to deteriorate due to the proliferation of fibrous tissue, which means that functional insufficiency will continue to progress.
Pancreatomyunostomy, as a simple operation with a minimal index of mortality and complications, may be recommended for the prophylaxis of fistula development in chronic pancreatitis, but the function of the gland worsens during resection, and the risk of mortality and complications increases.
Often when using pancreatitis, Whipple is used, but resection for lesions greater than 80% of the pancreas has limited indications and is rarely used.
When prescribing surgery, it should be borne in mind that resection of 70% or more of the normal gland will result in the development of intrasecretory and exocrine function deficiency. If resection is planned because of pain caused by an alcoholic form of chronic pancreatitis, consider the possibility of pancreatoduodenectomy or resection from 80% to 95% of the pancreas.
The disadvantage of such operations is the risk of diabetes after surgery, which is especially difficult for such a category of people as alcoholics or drug addicts.