Indications for surgical treatment and current techniques for chronic pancreatitis
Abstract
Introduction: Chronic pancreatitis is a progressive disease characterized by persistent inflammation, fibrosis, and functional loss of the pancreatic parenchyma. Despite advances in medical and endoscopic treatment, a subset of patients continues to experience intractable pain, local complications, or functional impairment requiring surgical intervention.
Method: A review of the scientific literature published from 2020 to 2025 was conducted using international databases (PubMed, Scopus, SciELO, and Cochrane Library). Clinical trials, systematic reviews, and clinical practice guidelines focusing on surgical indications and current techniques for the management of chronic pancreatitis were selected.
Development: Surgery remains the best option for patients with refractory pain, duodenal or biliary obstruction, and suspected malignancy. Drainage techniques, resection procedures, or hybrid approaches allow for individualized treatment based on ductal morphology and inflammatory involvement. The Frey and Beger procedures have demonstrated high effectiveness in pain control and preservation of pancreatic function, whereas pancreatoduodenectomy is reserved for localized lesions in the pancreatic head with suspected malignancy.
Final considerations: Appropriate selection of the surgical procedure, based on a multidisciplinary evaluation and the patient's anatomical characteristics, improves prognosis and quality of life. The current trend is moving toward less invasive techniques with greater functional preservation.
Downloads
References
1. Shimizu K, Ito T, Irisawa A, Ohtsuka T, Ohara H, Kanno A, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2021. J Gastroenterol. 2022[citado 20/06/2025];57(10):709-24. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35994093/
2. Löhr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch MM, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017[citado 20/06/2025];5(2):153-99. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28507771/
3. Testoni PA, Arcidiacono PG, Baron TH, Besselink MG, Boggi U, Boskoski I, et al. International consensus guidelines on interventional endoscopy in chronic pancreatitis. Pancreatology. 2020 [citado 20/06/2025];20(6):1239-52. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32600981/
4. van Veldhuisen CL, Kempeneers MA, de Rijk FEM, et al. Long-term outcomes of early surgery vs endoscopy first in chronic pancreatitis: follow-up analysis of the ESCAPE randomized clinical trial. JAMA Surg. 2025 [citado 03/07/2025];160(2):126-33. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39556965/
5. Zhou B, Zhang J, Li G, Wei Y, Xu S, Xu A, et al. The global, regional, and national burden of pancreatitis from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. J Gastroenterol Hepatol. 2025[citado 18/06/2025];40(5):1297-306. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40047071/
6. Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic pancreatitis. Lancet. 2020[citado 18/06/2025];396(10249):499-512. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32798493/
7. Lucchese S, et al. Partington-Rochelle modified procedure of pancreatotomy with short pancreaticojejunostomy for groove pancreatitis: a technical note. Updates Surg. 2025[citado 07/09/2025];77(4):1131-5. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39939302/
8. Nealon WH, Thompson JC. Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression: a longitudinal prospective analysis of the modified Puestow procedure. Ann Surg. 1993[citado 07/07/2025];217(5):458-66. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8489308/
9. Trần VT, Lê AX, Trần ĐBT, Nguyễn HT, Phạm MT, Trần HQ. Surgical management of chronic pancreatitis at Nghe An Friendship General Hospital. Vietnam Medical Journal. 2024[citado 17/07/2025];531(1). Disponible en: https://pubmed.ncbi.nlm.nih.gov/39557255/
10. Bachmann K, Tomkoetter L, Kutup A, Erbes J, Vashist Y, Mann O, et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg. 2013[citado 07/06/2025];258(5):815-20. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24096760/
11. Falconi M, Bassi C, Casetti L, Mantovani W, Mascetta G, Sartori N, et al. Long-term results of Frey's procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg. 2006[citado 04/07/2025];10(4):504-10. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16627230/
12. Pessaux P, Kianmanesh R, Regimbeau JM, Sastre B, Delcenserie R, Sielezneff I, et al. Frey procedure in the treatment of chronic pancreatitis: short-term results. Pancreas. 2006[citado 12/05/2025];33(4):354-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/17079932/
13. Roch AM, Brachet D, Lermite E, Pessaux P, Arnaud JP. Frey procedure in patients with chronic pancreatitis: short and long-term outcome from a prospective study. J Gastrointest Surg. 2012[citado 20/08/2025];16(7):1362-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/22580958/
14. Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery. 1985[citado 24/08/2025];97(4):467-73. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3985147/
15. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis: a prospective, randomized trial. Ann Surg. 1995[citado 17/08/2025];221(4):350-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/7748036/
16. Strate T, Bachmann K, Busch P, Mann O, Schneider C, Bruhn JP, et al. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology. 2008[citado 27/08/2025];134(5):1406-11. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18471514/
17. van Veldhuisen CL, Leseman CA, de Rijk FEM, Dekker EN, Wellens MJ, Michiels N, et al. Nationwide outcome of tailored surgery for symptomatic chronic pancreatitis based on pancreatic morphology: validation of the international guidelines. Ann Surg. 2025[citado 20/09/2025];;281(4):655-63. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39937897/
18. Croome KP, Tee M, Nagorney DM, Farnell MB, Kendrick ML, Truty MJ, et al. Pancreatoduodenectomy for chronic pancreatitis: results of a pain relief and quality of life survey 15 years following operation. J Gastrointest Surg. 2015[citado 27/05/2025];19(12):2146-53. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26432375/
19. Büchler MW, Friess H, Müller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg. 1995[citado 11/08/2025];169(1):65-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/7827806/
20. Issa Y, van Santvoort HC, Bakker OJ, Besselink MG, Boermeester MA, Bollen TL, et al. Effect of early surgery vs endoscopy-first approach on pain in patients with chronic pancreatitis: the ESCAPE randomized clinical trial. JAMA. 2020[citado 01/09/2025];323(24):2423-34. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32543682/
21. Yang CJ, Bliss LA, Schapira EF, Freedman SD, Ng SC, Windsor JA, et al. Systematic review of early surgery for chronic pancreatitis: impact on pain, pancreatic function, and re-intervention. J Gastrointest Surg. 2014[citado 02/09/2025];18(10):1863-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24916558/
22. Zhou Y, Shi B, Wu L, Peng Z, Chen S, Wang W, et al. Frey procedure for chronic pancreatitis: evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: a meta-analysis. Pancreatology. 2015;15(4):372-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26105077/
23. Yin T, et al. Long-term quality of life between duodenum-preserving pancreatic head resection and pancreatoduodenectomy: a systematic review and meta-analysis. Int J Surg. 2024. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38441943/
24. Hildebrand P, Duderstadt S, Jungbluth T, Roblick UJ, Bruch HP, Czymek R. Evaluation of the quality of life after surgical treatment of chronic pancreatitis. JOP. 2011;12(4):364-71. Disponible en: https://pubmed.ncbi.nlm.nih.gov/21731902/
25. Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Büchler MW, Warshaw AL, et al. International study group on pancreatic surgery definition of postoperative pancreatic fistula and grading of postoperative complications after pancreatic surgery. Surgery. 2010;147(1):15-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/20105550/
26. Cooper MA, Datta TS, Makary MA. Laparoscopic Frey procedure for chronic pancreatitis. Surg Laparosc Endosc Percutan Tech. 2014;24(2): e86-90. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24651392/
27. Minimally invasive total pancreatectomy with islet autotransplantation for chronic pancreatitis: the robotic approach. Surg Endosc. 2024;38(7):3948-56. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38758221/
28. Delhaye M, Arvanitakis M, Vooijs I, Matos C, Deviere J. Endoscopic therapy for chronic pancreatitis: a systematic review and meta-analysis. Gastrointest Endosc. 2019;89(4):710-22. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30639248/
29. Guda NM, Partington S, Freeman ML. Extracorporeal shock wave lithotripsy in the management of chronic calcific pancreatitis: a meta-analysis. JOP. 2005;6(1):6-12. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15645101/
30. Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003[citado 10/09/2025];35(7):553-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/12822088/
31. Conwell DL, Lee LS, Yadav D, Longnecker DS, Miller FH, Mortele KJ, et al. American Pancreatic Association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014[citado 14/09/2025];43(8):1143-62. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25262278/
32. Warshaw AL, Rattner DW. Facts and fallacies of common bile duct obstruction in chronic pancreatitis. Pancreas. 1989[citado 06/09/2025];4(3):264-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/2664926/
33. Cooper MA, Makary MA, Ng J, Cui Y, Singh VK, Matsukuma K, et al. Extent of pancreatic fibrosis as a determinant of symptom resolution after the Frey procedure: a clinico-pathologic analysis. J Gastrointest Surg. 2013[citado 11/09/2025];17(4):682-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23345052/
34. Leonhardt CS, et al. Patient reported outcomes of duodenum-preserving pancreatic head resection in chronic pancreatitis: high effectivity is impaired by prolonged non-surgical management. HPB (Oxford). 2024[citado 13/09/2025];. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39183122/
35. Gurusamy KS, Lusuku C, Halkias C, Davidson BR. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis. Cochrane Database Syst Rev. 2016[citado 15/09/2025] ;(2):CD011521. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26886377/
36. Guo S, et al. Duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy: a systematic review and network meta-analysis of surgical outcomes. Front Surg. 2023[citado 17/09/2025]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37273881/
37. Hackert T, et al. Endoscopic versus surgical management in chronic pancreatitis. Ann Surg. 2021[citado 20/09/2025];273(1):153-61. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32932313/
38. Gardner TB, Adler DG, Forsmark CE. Chronic pancreatitis: current concepts and management strategies. Gastroenterology. 2024[citado 22/09/2025]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39127354/
39. Sunagawa H, Tani M, Kawai M. Early surgical intervention improves long-term outcomes in chronic pancreatitis. Surgery. 2021[citado 27/09/2025];170(2):456-65. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33810995/
40. Salvia R, Crippa S, Bassi C. Current concepts in surgical management of chronic pancreatitis. Pancreatology. 2020[citado 29/09/2025];20(7):1302-12. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32919883/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Roberto Lázaro Blanco-Sosa, Carlos David Garcia Martin, Danny Conde Monroy
This work is licensed under a Creative Commons Attribution 4.0 International License.
All the articles can be downloaded or read for free. The journal does not charge any amount of money to the authors for the reception, edition or the publication of the articles, making the whole process completely free. Medisan has no embargo period and it is published under the license of Creative Commons, International Non Commercial Recognition 4.0, which authorizes the copy, reproduction and the total or partial distribution of the articles in any format or platform, with the conditions of citing the source of information and not to be used for profitable purposes.
![Secimed](/templates/images/secimed.png"){kind=small}
