Indications and Contraindications

Indications ■ Disabling abdominal pain

(Must Have All of Below) ■ Chronic pancreatitis - residual pancreatic damage, anatomic or functional, that persists even if the primary cause or other factors are eliminated

■ Cambridge Classification of Image Severity of "marked" chronic pancreatitis, i.e., main pancreatic duct stricture in head of gland (with or without stones, biliary stricture, or duodenal stenosis) or intrapancreatic head pseudocyst (with or without pseudoaneurysm)

■ Etiology has been remedied - gallstones or alcohol

■ Endotherapy failed with or without extracorporeal lithotripsy

Contraindications ■ Previous vagotomy and non-functional pylorus

(for Pylorus Preservation) ■ Pancreatic cancer discovered intraoperatively in the area of the anterior superior head of gland

■ History of severe peptic ulcer disease

■ Occluded portal or superior mesenteric vein (SMV) (look for large collaterals in hepatoduodenal ligament on CT)

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