Role of Surgical Treatment in Painful Chronic Pancreatitis

Chronic pancreatitis is a progressive inflammatory disease in which persistent abdominal pain is the major determinant of an impaired quality of life. Although medical and endoscopic therapies are commonly applied as initial treatments, many patients eventually require surgical intervention. In addition, the optimal timing of surgery and the choice of surgical procedure are controversial. The main goals of surgical treatment in chronic pancreatitis are durable pain relief, management of disease-related complications, and preservation of pancreatic function. Surgical options include drainage procedures, resection procedures, and combined approaches, depending on the pancreatic morphology, particularly main pancreatic duct dilatation and the presence of an inflammatory mass in the pancreatic head. Duodenum-preserving pancreatic head resection procedures, such as the Beger, Frey, and Berne techniques, have shown long-term pain control comparable to that of pancreaticoduodenectomy, with advantages in postoperative recovery and quality of life in selected patients. Recent evidence also suggests that earlier surgical intervention may provide better long-term outcomes than prolonged endoscopic management. In conclusion, surgical treatment should be considered an integral component of the management of chronic pancreatitis rather than a last-resort option. Appropriate patient selection and individualized choice of surgical technique are essential to optimizing the clinical outcomes.