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Surgical/specialist management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Surgery may be considered if ERCP demonstrates localised chronic pancreatitis or focal lesions, e.g. calculi; it may also be considered for intractable pain, pancreatic cysts and pseudocysts, and recurrent gastrointestinal haemorrhage.

Options include:

  • cholecystectomy with clearance of duct stones - essential if gallstones present
  • sphincterotomy of the accessory papilla in patients with pancreas divisum
  • drainage - percutaneous or surgical drainage of a pseudocyst or abscess
    • surgical (laparoscopic or open) drainage of pseudocysts that need intervention should be considered if endoscopic therapy is unsuitable or has failed (1)
  • partial resection - body and tail may be resected if pathology is limited to them. In other patients, a Whipple's procedure may be necessary
  • pancreatic duct obstruction (1)
    • surgery (open or minimally invasive) should be considered as first-line treatment in adults with painful chronic pancreatitis that is causing obstruction of the main pancreatic duct
    • consider extracorporeal shockwave lithotripsy for adults with pancreatic duct obstruction caused by a dominant stone if surgery is unsuitable
  • pancreatic ascites and pleural effusion (1)
    • consider referring a person with pancreatic ascites and pleural effusion for management in a specialist pancreatic centre
  • total pancreatectomy - total pancreatectomy has been considered a treatment of last resort because it leads to development of postoperative "brittle diabetes"
    • however, advances such as improved autologous islet cell transplantation have resulted in more-frequent use of total pancreatectomy in patients with disabling symptoms whose pancreatic morphology is not conducive to resection or decompressive surgery

Reference:

  • NICE (September 2018). Pancreatitis
  • Garcea G et al. Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: A series of 85 consecutive patients. Pancreas 2009 Jan; 38:1

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