Pancreatic duct stone management strategies: Advances and clinical practice in chronic pancreatitis

Table 4 Summary of surgical approaches for pancreatic duct stones

Surgical approach	Key benefits	Key risks/limitations
Pancreaticojejunostomy (e.g., Puestow, Frey procedures)	Provides effective decompression of the obstructed MPD. Achieves high rates of long-term pain relief and stone clearance. Aims to restore pancreatic juice flow and reduce intraductal pressure	Risk of postoperative pancreatic fistula, particularly if the MPD diameter is < 8 mm. Primarily indicated for patients with a significantly dilated MPD
Local pancreatic head resection with drainage (e.g., Beger, Frey procedures)	Excises diseased tissue (e.g., inflamed head, stones) while preserving duodenal integrity. Addresses concurrent biliary or duodenal obstruction. Reported long-term success rates for pain relief are high (e.g., approximately 90% for Frey procedure)	Technically more complex than drainage alone. Requires surgical expertise, especially for minimally invasive or robotic approaches
Pancreatectomy (pancreaticoduodenectomy or distal pancreatectomy)	Definitive resection for severe localized disease, suspected malignancy, or when less aggressive options fail. Eliminates the diseased pancreatic segment	Radical procedure with associated morbidity. May lead to endocrine or exocrine insufficiency, and the underlying chronic pancreatitis may progress in the remnant gland

MPD: Main pancreatic duct.