**4. Surgery for chronic pancreatitis – Drainage procedures**

For many years longitudinal pancreaticojejunostomy (LPJ) as described by Partington and Rochelle in 1960 was the favoured surgical option in the treatment of chronic pancreatitis. This involves entering and laying open of the pancreatic duct followed by a splenic preserving pancreaticojejunostomy without resection of the pancreatic tail (Partington PF, Rochelle REL. Ann Surg 1960). This procedure is relatively simple in comparison to many of the other available operations and has a low mortality and morbidity with maximal pancreatic tissue preserved. Pain relief in the short term approximates 75% but there is frequently recurrence in the long term (Bachmann K Best Pract and res Clin Gastro 2010). This is thought to be due to incomplete decompression of the main pancreatic duct, particularly in the head. There remains a residual inflammatory mass containing altered nerve fibres (Pessaux P Pancreas 2006) as well as obstructed second and third order ducts causing ongoing intraductal hypertension (Markowitz JS Arch Surg 1994). Current indications for this procedure are isolated dilatation of the pancreatic duct greater than 7mm or where the duct has a "chain of lakes" appearance without an inflammatory mass in the head (Yekebas EF Ann Surg 2006). Where the duct is undilated (less than 3mm) a longitudinal V-shaped excision of the ventral pancreas combined with a longitudinal pancreatico-jejunostomy has been described (Izbicki JR Ann Surg 1998, 227). This may be particularly useful when a sclerosing form of chronic pancreatitis results in so called small duct disease (Bachmann K Best Pract and res Clin Gastro 2010). Good results with pain relief in 89% of patients and comparable morbidity of 19.6% have been reported (Yekebas EF Ann Surg 2006).
