For which type of chronic pancreatitis is the "Hamburg procedure" indicated?

BACKGROUND: A pancreatic duct diameter (PDD) ranging from 4 to 5 mm is regarded as "normal". The "large duct" form of chronic pancreatitis (CP) with a PDD > 7 mm is considered a classical indication for drainage procedures. In contrast, in patients with so-called "small duct pancreatitis" (SDP) with a PDD <3 mm, extended resectional procedures are suggested including, as an "ultima ratio", even total pancreatectomy. METHODS: Between 1992 and 2008, among a total of 978 patients who were treated for CP, 51 suffered from SDP and underwent longitudinal "V-shaped excision" of the anterior aspect of the pancreas. The interval between symptoms and surgery varied from 12 to 123 months. Median follow-up was 87 months (range 32-131 months). A pain score was used as well as a multidimensional psychometric quality-of-life questionnaire. RESULTS: Hospital mortality was 0%. The perioperative morbidity (30 days) was 19.1%. Median pain score decreased by 95.5%. Global quality of life index increased in median by 53.6% (range 37.5-80%). In 35 patients (75%), complete pain relief was achieved. The impairment of exocrine and endocrine pancreatic function after surgery was statistically not significant. CONCLUSIONS: Longitudinal "V-shaped excision" of the ventral pancreas is a secure and effective approach for SDP, achieving significant improvement in quality of life and pain relief. While sparing patients from unnecessary, extended resectional procedures, it appears not to result in substantial deterioration of exocrine and endocrine pancreatic function.