Lateral pancreatojejunostomy in the surgical management of chronic pancreatitis. Current concepts and future perspectives.

Chronic pancreatitis is a medical disease, but surgery will be required for a selected subgroup of patients. Main indications for surgery in chronic pancreatitis are severe truly incapacitating pain refractory to medical therapy, local complications of pancreatitis or suspicion of malignancy. Surgical options include resective and drainage procedures. The choice of operation depends on the structural anatomy of the gland and the adjacent organs. Lateral pancreatojejunostomy is the preferred drainage procedure, because it is safe and effective in relieving the pain, while it preserves whatever pre-surgical pancreatic endocrine/exocrine function exists. It is indicated in large duct chronic pancreatitis (diameter of the main pancreatic duct >7 mm]; however, recently there is an increased interest in defining its role in small duct disease. The main advantage of the lateral pancreatojejunostomy over the resectional procedures is the preservation of the pancreatic parenchyma and endocrine and exocrine pancreatic function and the significantly lower early and late morbidity and mortality