A multicenter European study reveals significant variation in surgical approaches for chronic pancreatitis based on morphology, with no improvement in outcomes linked to guideline adherence.

• In this cohort of 207 patients, 90-day mortality was low at 1.4%, and 72.6% achieved pain relief at 6 months.
• Surgical techniques differed notably: duodenum-preserving resections were used most for combined dilated MPD and enlarged head (46.8%), while formal pancreatectomy was predominant for isolated dilated MPD (63.3%) and small duct disease (66.0%).

While guidelines were followed 66% of the time, adherence did not correlate with reduced morbidity or enhanced pain relief, indicating a pressing need for clearer, unified surgical recommendations in the management of chronic pancreatitis.