Indications and Contraindications

Indications ■ Incapacitating abdominal pain, usually of a continuous nature, and in selected patients also when intermittent and frequent or associated with recurrent attacks of acute pancreatitis

■ Resolution of pancreatic and extrapancreatic structural complications associated with chronic pancreatitis

- Extrapancreatic - common bile duct obstruction, duodenal obstruction, selected patients with compression of portal and/or superior mesenteric veins

- Pancreatic

- Parenchymal: scarring, multiple fibrous strictures of duct ("chain of lakes") with calcification, ductal hypertension, retention cysts, ductal stones

- Ductal disruptions: contained - pseudocyst; uncontained - ascites; fistula -pleural or pericardial

■ Inadequate pain relief after ductal drainage procedure or distal pancreatectomy

■ Pancreas divisum causing chronic pancreatitis

Contraindications

■ Absolute contraindications:

- Findings which raise concern of potential malignancy are absence of history of alcoholism, hyperlipidemia, hyperparathyroidism, recent history of onset of pain, and increased serum CA 19-9 level

- If cancer cannot be excluded, a resective operation is suggested, i. e., pancreato duodenectomy or distal pancreatectomy

- Complete thrombosis of superior mesenteric/portal venous junction with peripancreatic varices

■ Relative contraindications:

- Disease limited to the body and tail of gland (infrequent)

- Unrelenting narcotic addition or when the patient refuses the concept of postoperative detoxification

- Inability to manage possible postoperative diabetes mellitus due to anticipated poor compliance

- Obstruction of superior mesenteric/portal vein junction with mild to moderate portal hypertension a contraindication.

■ Ducts in the pancreatic head (body or tail) are either resected or unroofed and thereby decompressed; a jejunal Roux limb can be sewn to the pancreatic capsule.

Other Considerations not

The "small" pancreatic duct (<3-4mm) in the head,body, or tail of the pancreas is

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