Surgical treatment of chronic pancreatitis: the state of the art

Chronic pancreatitis is a common disease accompanied with considerable morbidity and mortality. Complications associated with chronic pancreatitis, such as pseudocysts, stenosis of adjacent anatomic structures or pain that cannot be managed conservatively, may be treatable surgically or interventionally by endoscopy. Surgery is superior to endoscopy in regard to long-term pain management. Modern duodenum preserving pancreatic resections using the Berger, Frey, or Hamburg techniques possess a number of substantial drawbacks. Duodenum preserving pancreatic resection is the surgical procedure of choice in patients with inflamed changes of the head of the pancreas. Despite great progress in recent years regarding the management of complications, postoperative morbidity is high. The best timing of surgery, the ideal standardized perioperative management are the focus of current research. The minimally invasive approach offers numerous benefits in comparison with open surgery, but these procedures can only be performed at highly specialized centers with very highly qualified surgeons.