Pancreatic surgery: critical evaluation and perspectives.

While in the majority of cases, edematous pancreatitis responds to purely conservative intensive medical therapy, the hemorrhagic necrotizing form requires surgical treatment. The best results can be obtained with extensive necrosectomy followed by post-operative irrigation sump drainage. If possible, surgery should be delayed to between the 6th and 10th day after the onset of the disease. In the surgical therapy of chronic recurrent pancreatitis, the indirect and organ-preserving procedures have not gained widespread acceptance. While total duodenopancreatectomy must be rejected as too risky, good long-term results can be obtained with resection of the main inflammatory lesion, coupled with inter-operative occlusion of the remaining part of the organ to prevent recurrent disease. The surgical treatment of periampullar and ductal carcinoma of the pancreas should be made more radical by performing regional lymphadenectomy in the upper abdomen, both in the case of partial and in total duodenopancreatectomy. With this procedure, not only can the resection rate be increased by a factor of 2 to 3, but lymph node metastases of the second station, which would escape conventional therapy, are also removed.