*4.4.1 Total pancreatectomy with islet autotransplantation (TPIAT)*

Children with chronic pancreatitis who suffer recurrent severe episodes of abdominal pain, chronic use of analgesics (opioids) and frequent hospitalizations may benefit from TPIAT, in order to improve their quality of life. A multidisciplinary team including gastroenterologists, endocrinologists, surgeons, anesthesiologists, psychologists, radiologists and nutritionists guides the selection of these patients.

Thus the procedure consists in a demolitive operative phase, followed by a reconstructive one that includes an hepaticojejunostomy plus gastrojejunostomy or a duodenojejunostomy and the autotransplantation of islets via the portal vein.

Osmotic, mechanical or hypoxia damage of islets should be considered, especially in the pre-engraftment phase and the risk of developing diabetes mellitus must be accepted by families.

Anyway pain resolution, independence from analgesics and significant improvement in quality of life has been reported in the majority of children with CP following TPIAT, and glycemic control is managed without difficulty [24, 27].
