Pancreatic surgery.

Several important advances in pancreatic surgery have been made over the past year. As in other areas of general surgery, laparoscopic techniques are being used with increasing frequency, but their real value remains to be determined. Methods to stage pancreatic cancer, perform palliative bypass, relieve pain, and perform distal pancreatic resections have been described. Using more conventional surgical approaches, data continue to accumulate about pylorus preserving pancreaticoduodenectomy as an alternative to the standard operation. The survival benefit of extended pancreatic resection for pancreatic cancer remains dubious. Studies continue to demonstrate lower morbidity and mortality rates for pancreaticoduodenectomy performed at high-volume centers. In the arena of chronic pancreatitis, pain relief is still the most common reason for surgical treatment, and the efficacy of various operations has been assessed by some new studies. Data continue to show that aggressive surgical treatment for infected necrosis leads to improved survival in patients with severe acute pancreatitis.