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
- 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
■ 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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