Acute pancreatitis and chronic pancreatitis are distinct conditions that share the name but differ in their mechanism, their clinical course, and their surgical management. Acute pancreatitis is an episode of sudden inflammation of the pancreas, most commonly caused in India by gallstones or alcohol, and ranging from mild self-limiting illness managed with IV fluids and analgesia to severe necrotising pancreatitis where portions of the pancreatic tissue die, producing infected necrosis that may require surgical or minimally invasive drainage. Mild acute pancreatitis resolves without specific intervention beyond supportive care. Severe acute pancreatitis with pancreatic necrosis is managed with a step-up approach: initial supportive care in an intensive care setting, followed by minimally invasive necrosectomy if infected necrosis develops, with open surgery reserved for cases that do not respond to less invasive approaches. For gallstone pancreatitis, laparoscopic cholecystectomy is performed once the acute episode has resolved and before discharge or in the same admission for mild cases, to prevent recurrence. Chronic pancreatitis is a progressive inflammatory condition of the pancreas, again most commonly from alcohol or from recurrent acute episodes, in which the normal pancreatic tissue is progressively replaced by fibrosis. This produces recurrent pain, exocrine insufficiency (digestive enzyme deficiency requiring supplementation), and endocrine insufficiency (diabetes). The biliary or duodenal obstruction that advanced chronic pancreatitis can cause through the surrounding fibrosis may require surgical bypass procedures. Pancreatic duct stones in chronic pancreatitis may require endoscopic or surgical drainage. The assessment and management of pancreatitis at Narayana Multispeciality Hospital and RK Speciality Clinic, Mysuru, is guided by the specific type, severity, and complications of each patient's individual disease, and the surgical decision is always made with the full clinical picture in view.
Written by Dr. Lokesh H M, MBBS, MS, MCh Surgical Gastroenterology, Fellowship Pancreato-Biliary Surgery (SGPGIMS Lucknow), FMAS, Senior Consultant Surgical Gastroenterologist, Narayana Multispeciality Hospital and RK Speciality Clinic, Mysuru. Phone: +91 89719 08095.
