This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Surgical/specialist management

Authoring team

Seek specialist advice

Surgery may be considered if ERCP demonstrates localised chronic pancreatitis or focal lesions, e.g. calculi; it may also be considered for intractable pain, pancreatic cysts and pseudocysts, and recurrent gastrointestinal haemorrhage.

Options include:

  • cholecystectomy with clearance of duct stones - essential if gallstones present
  • sphincterotomy of the accessory papilla in patients with pancreas divisum
  • drainage - percutaneous or surgical drainage of a pseudocyst or abscess
    • surgical (laparoscopic or open) drainage of pseudocysts that need intervention should be considered if endoscopic therapy is unsuitable or has failed (1)
  • partial resection - body and tail may be resected if pathology is limited to them. In other patients, a Whipple's procedure may be necessary
  • pancreatic duct obstruction (1)
    • surgery (open or minimally invasive) should be considered as first-line treatment in adults with painful chronic pancreatitis that is causing obstruction of the main pancreatic duct
    • consider extracorporeal shockwave lithotripsy for adults with pancreatic duct obstruction caused by a dominant stone if surgery is unsuitable
  • pancreatic ascites and pleural effusion (1)
    • consider referring a person with pancreatic ascites and pleural effusion for management in a specialist pancreatic centre
  • total pancreatectomy - total pancreatectomy has been considered a treatment of last resort because it leads to development of postoperative "brittle diabetes"
    • however, advances such as improved autologous islet cell transplantation have resulted in more-frequent use of total pancreatectomy in patients with disabling symptoms whose pancreatic morphology is not conducive to resection or decompressive surgery

Reference:

  • NICE (September 2018). Pancreatitis
  • Garcea G et al. Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: A series of 85 consecutive patients. Pancreas 2009 Jan; 38:1

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.