Changing trends in the minimally invasive surgery for chronic pancreatitis

Abstract

Chronic pancreatitis is a debilitating pancreatic inflammatory disease characterized by intractable pain resulting in poor quality of life. Conventional management of pancreatic pain consists of a step-up approach with medications and lifestyle modifications followed by endoscopic intervention. Traditionally surgery is reserved for patients who do not improve with other interventions. However, recent studies suggest that early surgical intervention is more beneficial as it can mitigate the progression of the pathological process and prevent loss of pancreatic function. Despite the widespread adoption of minimally invasive approaches in various gastrointestinal surgical disorders, minimally invasive surgery for chronic pancreatitis is slow to evolve. Technical difficulty due to severe inflammatory changes has been the major impediment to the widespread usage of minimally invasive surgery in chronic pancreatitis. With this background, the present review aimed to critically analyze the available evidence on the minimally invasive treatment of chronic pancreatitis. A Pub Med search of all relevant articles was performed using the appropriate keywords, parentheses, and Boolean operators. Most initial laparoscopic series have reported the feasibility of lateral pancreaticojejunostomy, considered an adequate procedure only in a small proportion of patients. The pancreatic head is the pacemaker of pain, so adequate decompression is critical for long-term pain relief. Recent studies have documented the feasibility of minimally invasive duodenum-preserving pancreatic head resection. With improvements in laparoscopic instrumentation and technological advances, minimally invasive surgery for chronic pancreatitis is gaining momentum. However, more high-quality evidence is required to document the superiority of minimally invasive surgery for chronic pancreatitis.

Keywords: Robotics; Laparoscopy; Surgery; Chronic pancreatitis; Pancreas; Pancreatitis

Core Tip: Pain in chronic pancreatitis is a significant symptom that demands utmost attention as it compromises the quality of life and inherently risks narcotic addiction. Surgical management for chronic pancreatitis began with various open surgical drainage and resection procedures. Since pain is the primary indication for intervention, a minimally invasive approach is an attractive proposition in chronic pancreatitis. Despite the slow adoption of laparoscopic and robotic surgery in chronic pancreatitis, safety, and feasibility have been documented in recent studies. The challenges and limitations highlighted in the present review could guide future research on minimally invasive surgery in chronic pancreatitis.