Surgical management of chronic pancreatitis on the continent of Europe.

Surgical management of chronic pancreatitis remains a difficult problem. On the continent of Europe, the main etiology of the disease is alcoholism; thus, alcohol withdrawal is mandatory before surgical treatment. Left splanchnicectomy is no longer used. Total and left subtotal pancreatectomy are abandoned due to their high mortality rates and their severe metabolic sequelae. Distal pancreatectomy is presently reserved for the cases in which the head of the pancreas is least involved. The choice between pancreaticojejunostomy and pancreaticoduodenectomy remains debated. The former has a low postoperative mortality rate while reoperation is less frequent after the latter. Current trends in Europe are to perform more anastomoses and less resections than some years ago. Pancreaticoduodenectomy, however, retains an important role in cases with biliary or duodenal involvement. Whatever the choice of the procedure, the surgical treatment of chronic pancreatitis remains palliative and does not alter the natural course of the disease. The quality and duration of the results depend mainly on alcohol withdrawal.