Pancreatitis Surgery Dhaka

Surgery is reserved for infected pancreatic necrosis (typically >4 weeks after onset, when collections are walled-off) or sterile necrosis with persistent organ failure. Modern management follows a step-up approach: percutaneous drainage first, then minimally-invasive video-assisted retroperitoneal debridement (VARD), then open necrosectomy only if needed. This approach has halved mortality compared to early open surgery.

• Infected walled-off necrosis — step-up drainage and necrosectomy
• Pseudocyst >6 cm or symptomatic — endoscopic or surgical cystogastrostomy
• Disconnected pancreatic duct syndrome — distal pancreatectomy or internal drainage
• Haemorrhage from pseudoaneurysm — angiographic embolisation, with surgery as backup
• Bowel perforation or ischaemia — emergency laparotomy

Chronic pancreatitis causes intractable pain, ductal obstruction, and progressive endocrine/exocrine failure. Surgery is offered when medical and endoscopic therapy fail. The choice depends on duct anatomy:

• Frey procedure (head coring + lateral pancreaticojejunostomy) — for head-dominant disease with dilated duct
• Puestow (lateral pancreaticojejunostomy) — for diffusely dilated duct without inflammatory mass
• Beger / Berne procedure — duodenum-preserving head resection
• Distal pancreatectomy — for tail-predominant disease

Step-up necrosectomy reduces mortality from infected necrosis to 10–20% (versus 40–50% with early open surgery). For chronic pancreatitis, the Frey procedure provides durable pain relief in 80–85% of patients at 5 years while preserving pancreatic function. Book a consultation if you have ongoing pancreatic pain or recurrent attacks.