Surgical Therapy of Chronic Alcoholic Pancreatitis: A Literature Review of Current Options

Abstract

Chronic pancreatitis (CP) is associated with alcohol abuse in 80% of cases. The primary treatment goals in CP are pain reduction and avoidance of pancreatitis-associated complications. CP should be treated in an interdisciplinary approach. A recent randomized clinical trial showed that early surgery compared with an endoscopy-first approach resulted in reduced pain levels. Surgical resections are, therefore, the most efficient treatment of pancreatitis-associated pain as well as other complications and should be performed early in the course of the disease. Since most of the patients pre-sent with chronic inflammation of the pancreatic head, pancreatic head resection is the most common treatment option. Duodenum-preserving pancreatic head resections are the surgical procedure of choice, but pancreaticoduodenectomies (Kausch-Whipple procedures) demonstrate similar outcome with regard to pain control, quality of life, and metabolic parameters. Other surgical procedures, including drainage procedures, pancreatic segmental resections, or left resections, are rarely indicated.

Keywords: Chronic pancreatitis; Duodenum-preserving pancreatic head resection; Pancreatic resections; Pancreaticoduodenectomy; Surgical treatment.

Fig. 1

The duodenum-preserving pancreatic head resection according to Beger comprises a resection of the pancreatic head with preservation of a parenchymal cuff along the duodenum and the preservation of the dorsal pancreatic capsule as well as the transection of the pancreas over the portal vein. It is reconstructed with 2 anastomoses: one to the resection cavity and one to the pancreatic body.

Fig. 2

Frey's duodenum-preserving pancreatic head resection involves a circumscribed exfoliation of the pancreatic head which is combined with a longitudinal pancreatic jejunostomy.

Fig. 3

The Bern modification combines the advantages of the duodenum-preserving pancreatic head resection of Beger and Frey. Accordingly, a deep, subtotal resection of the pancreatic head without transection of the pancreas over the portal vein is performed. This technique does not include the opening of the pancreatic duct of the pancreatic tail and the longitudinal pancreaticojejunostomy.