The quality of life in chronic pancreatitis: the role of surgery.

Pain represents the main symptom of chronic pancreatitis (CP) and it may be considered the most important factor affecting the quality of life in patients having this pathology. Although the therapy for CP consists primarily of conservative and symptomrelated treatment, long-term follow-up studies have demonstrated that about 50% of all patients will undergo surgical treatment at some time in the course of the disease [1]. In the past two decades, our knowledge of the pathophysiology and surgical treatment options in CP have improved substantially. Surgical treatment in CP has evolved from radical to organ-preserving procedures. These procedures allow the preservation of exocrine and endocrine pancreatic function, provide pain relief in up to 90% of patients, and contribute to an improvement in the quality of life. For decades, the classical Whipple resection has served as the standard operation for treating patients with CP, even though the long-term success of this procedure in patients with CP has not been satisfactory. In the United States, the pylorus-preserving Whipple resection is steadily replacing the classic Whipple procedure as the surgical standard used to treat patients with CP. The pylorus-preserving Whipple provides better postoperative results regarding quality of life and weight gain. However, many patients develop postoperative diabetes mellitus, which contributes to late morbidity and mortality. A major disadvantage of the pylorus-preserving Whipple is the resection of the duodenum which plays a central role in the postprandial regulation of the digestive process and glucose metabolism. Therefore, recent years have seen attempts to develop more organ-preserving operations, such as the duodenum-preserving pancreatic head resection (DPPHR) introduced by Beger et al. [2] or the longitudinal pancreaticojejunostomy with local pancreatic head resection introduced by Frey et al. [3]. Both procedures are safe and effective in providing long-term pain relief and in treating the complications occurring with CP. With preservation of the physiological food passage, patients gain weight faster, have less pain, and demonstrate better exocrine and endocrine pancreatic function postoperatively. Even though many surgeons all over the world still perform the classic or the pylorus-preserving Whipple resection, the superiority of the duodenumpreserving pancreatic head resection in CP over these two methods has been clearly proven in several prospective, randomized trials [4, 5]. Therefore, this organ-preserving operation in the treatment of CP should be recommended as standard procedure.