title: Review article: Surgical management of chronic pancreatitis.
abstract: BACKGROUND
  The therapeutic approach to patients with chronic pancreatitis (CP) is complicated by the fact that patients are presented to the physician at different stages of disease and in the presence of varying clinical symptoms. Generally, an expectant approach is justified for patients with asymptomatic CP. At present, patients with symptoms related to gland destruction are initially treated by endoscopic means, while surgical treatment of CP is usually reserved for intractable abdominal pain, suspicion of cancer, and complications such as persistent pseudocysts.
  
  
  OBJECTIVE
  To review the studies currently available evaluating surgical and/or endoscopic management of CP.
  
  
  RESULTS
  Improvements in imaging techniques, as well as a better understanding of the pathophysiology of CP and mechanisms causing pain, have led to a more conscious selection of patients for surgery. Type of surgery depends on whether the pancreatic duct is dilated, presence of an inflammatory mass and occurrence of complications (pseudocysts, gastric outlet obstruction). Eventually, after initial endoscopic treatment, a substantial number of patients still need surgery for persistent complaints.
  
  
  CONCLUSIONS
  For patients with symptomatic CP, a multidisciplinary approach is indicated with low threshold to surgical intervention, since long-term pain relief is accomplished more often after surgical treatment than after endoscopic treatment.
authors: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors: N A
authors: NA
authors: van der Gaag
authors: D J
authors: DJ
authors: Gouma
authors: T M
authors: TM
authors: van Gulik
authors: O R C
authors: OR
authors: Busch
authors: M A
authors: MA
authors: Boermeester
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D002779:Cholestasis / Q000209:etiology / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000209:etiology / Q000601:surgery*