Pancreatic surgery in patients with chronic pancreatitis and extrahepatic portal hypertension: a systematic review

Introduction: Chronic pancreatitis (CP) is a progressive and permanent destruction of pancreas, resulting in disabling pain and loss of endocrine/exocrine function. The indications for surgery include intractable pain, suspected malignancy or complications/combinations of the previous. Certain conditions can increase morbidity-mortality risk, such as extrahepatic portal hypertension (EPH). This complication of CP represents a surgical risk that must be accounted for in the design of a surgery. Method: This study is a systematic review on the existence of EPH in patients undergoing surgery for CP. Adhering to PRIMSA guidelines (PRISMA12NL), a systematic search was performed in PubMed/Embase, for articles on EPH and pancreatic surgery for CP. Results: 518 articles were obtained, only 8 focused on pancreatic surgery in patients with CP and vascular abnormalities (two case report, six series of cases). The existence of EPH in patients with CP undergoing surgery increases intraoperative blood loss, postoperative morbidity and mortality. The results are shown in Figure 1. Pancreatic surgery in patients with CP has good results in terms of pain reduction and improvement of disability, but it leads to high morbidity and mortality in those patients who associate EPH. Conclusions: Literature on surgery for CP and EPH is scarce and confusing. Studies are limited series which mix different types of surgery and different vascular affectations. So, it would be necessary more studies to know if there is any technique of choice in these patients or if some of them should not be candidates for surgical treatment.