The role of surgery in chronic pancreatitis

BackgroundChronic pancreatitis (CP) remains acomplex condition resulting in significant morbidity and suffering in patients, often over along period of time. Treatment is mostly centred on aconservative approach, with avariety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques.MethodsThis review provides an overview of current treatment options for CP, the literature search was performed via PubMed. Personal experiences from the authors on how to approach the disease from the surgeon's perspective are added. The outline includes pathophysiologic aspects, classifications and patient-centred surgical approaches.ResultsThere has not been astandardized treatment for CP so far as clinical and radiological appearance of the disease have awide range due to great heterogeneity of this complex disease; therefore, level1 evidence for treatment of CP remains low. More recently, different approaches to surgical management have been trialled. With personalized surgery, long-term pain relief is achievable in up to 90% with low morbidity. Autologous islet cell transplantation is afeasible option in selected patients to avoid endocrine insufficiency.ConclusionAtailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. Amultidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.