The surgical strategy is largely governed by morphological
changes to parenchymal and pancreatic ductal tissue. As much as possible of the normal upper gastrointestinal anatomy
and pancreatic parenchyma should be preserved to avoid problems with diabetes mellitus and malabsorption
of fat. The currently favoured operations are duodenal preserving resection of the pancreatic head (Beger
procedure) and extended lateral pancreaticojejunostomy (Frey's procedure). More extensive resections such
as Whipple's pancreatoduodenectomy and total pancreatectomy are occasionally required. The results of
surgery are variable; most series report a beneficial outcome in 60-70% of cases at five years, but the benefits
are often not sustainable in the long term. It is often difficult to determine whether failures are
surgically related or due to narcotic addiction.
In this operation no tissue is removed but the dilated main pancreatic
duct is drained into the small bowel by a Roux-en-Y procedure. This operation is used if the pancreas is not badly affected
apart from obstruction to the pancreatic duct.
This is almost identical to the Peustow operation but some tissue
is removed from the head of the pancreas although less than in Beger's operation. A Roux-en-Y enterostomy is used to drain
the cut parts of the pancreas.