Organ erhaltende operationsverfahren bei chronischer pankreatitis - Die duodenum erhaltende pankreaskopfresektion

Chronic pancreatitis is a benign inflammatory process of the pancreas that leads to permanent damage of the gland and loss of functional parenchyma. The evolution of the disease is progressive and associated with development of exocrine and endocrine pancreatic insufficiency, with a higher risk of developing pancreatic cancer. Alcohol abuse is the most frequent etiology for chronic pancreatitis in Western industrialized countries. The predominant symptom of chronic pancreatitis is pain, and it is often difficult to control pain sufficiently with analgesics. Other symptoms are diabetes mellitus, steatorrhea and weight loss. The diagnosis of chronic pancreatitis is usually made on a medical history, but retrograde endoscopic pancreaticography (ERCP) and an abdominal contrast-enhanced CT scan are still the gold standards for diagnosis and staging. However, the conventional MRI combined with MR angiography and MR cholangio-pancreaticography is a very challenging alternative. Indications for surgery are severe abdominal pain with pancreatic head enlargement, common bile duct stenosis, intestinal obstruction, compression of retropancreatic vessels or suspicion of malignancy. The duodenum-preserving pancreatic head resection (DPPHR) is an organ-preserving operation, which was developed to replace the Whipple procedures in patients with chronic pancreaitis. It eliminates chronic pancreatitis-related complications and leads to pain relief. In this procedure, the pancreatic head is resected subtotally, and the body and tail of the pancreas, the stomach, the duodenum, and the extrahepatic bile duct are preserved. In an own series of 298 patients, hospital mortality was 1% and the most frequent perioperative complication was bleeding in 5.7% of the patients. Pancreatic fistulas occurred in 2.7% of the patients, and the total reoperation rate was 5.7%. After an average follow-up of 5.7 years, 91% of the patients with DPPHR were free of pain or with minimal signs of disease. 63% of the patients were professionally active. Late mortality was 12.6%. DPPHR in chronic pancreatitis is a safe and effective operation procedure providing long-term pain relief in treating chronic pancreatitis-related complications. Therefore, this organ-preserving procedure should be considered as first procedure to treat chronic pancreatitis-related complications.