What Are the Surgical Treatments for Pancreatitis?

Pancreatitis occurs when the pancreas, a large gland near the stomach, becomes swollen and irritated due to inflammation. The pancreas has two jobs. It produces insulin to regulate blood sugar. It also produces digestive enzymes to break down food in the intestines. Pancreatitis can cause symptoms like severe belly (abdominal) pain, nausea, vomiting and fever.

There are three types of pancreatitis: acute, acute recurrent and chronic. Treatment varies based on the type of pancreatitis each child has and the frequency of acute episodes of pancreatitis. Most children have acute pancreatitis and recover in a few days, with no permanent damage to the pancreas. Treatment mainly includes intravenous (IV) fluids, nutrition and pain relief.

When Typical Treatment Is Not Enough

Chronic or acute recurrent pancreatitis in children is rare. When it occurs, though, it really impacts a child’s quality of life. It can include constant belly pain, emergency department visits, frequent hospitalizations, a lot of pain medication and many missed school days.

In some cases, complications such as fluid collections or narrowing of the ducts (tubes) in the pancreas may occur. This may require an endoscopic intervention, called endoscopic retrograde cholangiopancreatography (ERCP). ERCP can be used to take a better look at the pancreatic duct. A balloon can then be used to dilate or stretch the area that has narrowing (a stricture) in the pancreatic duct. A stent can keep the narrowed area open as it heals.

Surgical Treatment for Pancreatitis

Surgery may be needed for children who have acute recurrent or chronic pancreatitis with severe (debilitating) pain symptoms and impaired quality of life. Possible surgical procedures include:

• Removal of a portion of the pancreas (resection)
• Drainage operation (to improve the drainage of the duct system)
• A combination of drainage and resection
• Total pancreatectomy with islet autotransplantation (TPIAT)

TPIAT may be an option for patients when drainage operations or partial resections are not an option, other approaches have not worked, or there is a genetic predisposition for pancreatitis. The primary goal of TPIAT is to relieve pain and improve quality of life by removing the pancreas. Islets are isolated from the pancreas and autotransplanted into the liver to reduce the risk of diabetes.

What Are the Most Common Reasons for Surgery for Pancreatitis?

• Relief from persistent pain that impacts quality of life
• Pain that can’t be relieved by medication or endoscopic approaches
• Help the patient wean off opioid pain medication
• Preserve the health and function of the pancreas, including making insulin and glucagon to maintain blood sugar levels and enzymes to help digest food

The causes of pancreatitis and care can differ between children and adults. That’s why children with pancreatitis should be treated by pediatric experts. Children with more complications should be seen at a National Pancreas Foundation Center of Excellence like the Pancreas and Liver Care Center at Nationwide Children’s.