A brief history of modern surgery for chronic pancreatitis

The approaches to treating chronic pancreatitis that have persisted to date are as follows: denervation of the pancreas, visceral, autonomic splanchnicectomy; pancreatic resection, distal based versus proximal based; ductal drainage; and islet (auto)transplantation after resection. The primary symptom of chronic pancreatitis is PAIN, and the visceral, autonomic nerves rather than the somatic nerves mediate this form of deep‐seated, boring epigastric and back pain. Parenchymal resections of ≥ 80% produced pain relief in 80% of patients, which was no better than operations such as pancreatoduodenectomy that preserved a greater amount of pancreatic parenchyma. The success of the 95% distal pancreatectomy and pancreatoduodenectomy focused attention to the head of the pancreas as the principal anatomic target in pain relief. Two types of chronic pancreatitis were noted both intra‐operatively and preoperatively with the development of cross‐sectional imaging: small‐duct disease and large‐duct disease.