Role of Surgery in the Treatment of Pancreatitis and Its Complications

The nosography of pancreatitis has been modified because the established distinction between acute and chronic pancreatitis is under critical revision. In this argument there is a reduced availability or absence of histological data connected to a clinical picture; on the other hand the various classifications are based exclusively on clinical or laboratory data or on imaging exams [1]. Moreover, the extremely diversified territorial distribution of the various forms of pancreatitis generates uncertainties: this often provides different experiences to different observers. The rigorous distinction between acute and chronic pancreatitis has represented the basis of classifications in which there have been two distinct diseases. More recently, more comprehensive, prolonged and detailed clinical observations have enabled a more thorough knowledge of pancreatitis. These observations show that acute and chronic pancreatitis overlap [1]. According to these new perspectives, two clinical pictures should be reviewed and reconsidered: the onset and/or the acute manifestations of chronic pancreatitis due to severe tissue inflammation more evident than main/branch duct dilation; and acute pancreatitis that evolves anatomo-clinically towards chronic forms, because of the recurrence of acute episodes with evolution of inflammation in fibrosis, sclerosis and calcifications. The aim of the chapter is to evaluate surgical procedures with a minimally invasive approach as the preferred choice, demonstrating separately the diagnostic and therapeutic pathways for acute and chronic pancreatitis.