Surgical therapy in chronic pancreatitis.

Chronic pancreatitis should be treated medically until a surgically correctable complication develops. Incapacitating abdominal pain refractory to medical therapy is the most common indication for operation. Preoperative evaluation of chronic pancreatitis should include a dynamic computed tomography scan to evaluate the pancreas and pancreatic duct. If the pancreatic duct is not seen or is not dilated on computed tomography, an endoscopic retrograde cholangiopancreatogram should be performed. If the pancreatic duct is dilated more than 5 mm, a side-to-side pancreaticojejunostomy should be performed in symptomatic patients. If the pancreatic duct is not dilated and all other causes of pain have been ruled out, a pylorus-preserving Whipple resection or duodenum-preserving pancreatic head resection should be performed. Distal pancreatectomy is reserved for disease isolated to the tail. Total pancreatectomy is used only as a salvage procedure and, whenever possible, should be accompanied by autotransplantation of the residual gland or islet cells.