Short-Term and Long-Term Outcome after Interventional and Surgical Treatment of Chronic Pancreatitis with Inflammatory Mass

No cause or curative approach has yet been found for chronic pancreatitis and therapy is rather symptom-oriented. Consequent avoidance of injuring factors, which most frequently demands absolute abstinence from nicotine and alcohol, adequate pain management, and treatment of exocrine and endocrine pancreatic insufficiency through application of enzymes and substitution of insulin allow for distinct therapeutic targets. Furthermore, interventional and operative options are available for therapy of obstructive pancreatitic disorders and for treatment or prevention of complications of chronic pancreatitis with stenosis of the pancreatic duct or common bile duct or development of pseudocysts. The options can be distinguished as resective procedures and draining procedures. However, the choice between an endoscopic or radiologic interventional approach and an operative approach has to be reassessed individually in every case, always bearing in mind the cluster of symptoms, the development of the disease, and the patient's clinical status. The indications for operative draininage have been made more restrictive because of improvements in endoscopy. Nevertheless, chronic pancreatitis demands surgical action whenever pain or organ complications cannot be brought under control by medical or interventional therapy. This chapter gives an overview of short- and long-term outcomes of the distinct therapeutic procedures and thereby evaluates their respective significance within the overall therapeutic concept of chronic pancreatitis.