Commentary

Abstract

From the pathophysiologic point of view, operative therapy of chronic pancreatitis (CP) includes primarily drainage procedures and resection of chronically-inflamed tissue which must be considered in the context of two aspects. First, ductal or pseudocyst drainage without resection is the maximal, parenchyma-sparing approach which offers – at least theoretically – preservation of all residual endocrine and exocrine function. Second, the remaining fibrotic tissue may be responsible for ongoing symptoms, especially pain. Besides, drainage alone offers only limited functional benefit if the tissue preserved has been subjected to long-lasting inflammation and maintains an ongoing, increased risk of malignant transformation. The generation of pain as the leading symptom in CP is highly complex and not fully understood. It is generally accepted that pancreatic ductal and possibly parenchymal hypertension and perineural inflammation are the two main mechanisms of pain generation in CP. From the clinical course, pain is an early symptom in patients with CP who manifest an increasing tendency toward ongoing and escalating pain in the long term, despite any new obvious parenchymal changes or new stimuli (e.g. pseudocysts, enlargement, etc.) (Vardanyan and Rilo 2010). Thus, pain management should be started as early as possible to avoid the end stage of chronic and irreversible pain.