The management of chronic pancreatitis remains challenging, and while advances in endoscopy, imaging, and surgery have improved outcomes, it is harsh testimony that a total pancreatectomy, the earliest operation performed for CP back in 1946, is still a treatment option for a benign disease that was identified on autopsy more than 200 years ago. Today we are joined by Professor Ajith Siriwardena, head of HPB at Manchester University, Past President of the E-AHPBA and internationally recognised for his work in pancreatic surgery and chronic pancreatitis. We will discuss practical decision-making in chronic pancreatitis, from medical therapy and pain management through to complex resections. Guest Bio: Professor Ajith Siriwardena is a Professor of HPB Surgery at the University of Manchester and Consultant Hepatobiliary and General Surgeon at Manchester Royal Infirmary. Following training in Manchester and Edinburgh, he undertook advanced liver surgery training in Paris, and subsequently worked in Scotland’s national liver surgery unit before taking up his consultant position in Manchester in 1999. He has built an extensive academic and clinical career in HPB oncology, with particular expertise in liver and pancreatic surgery and colorectal liver metastases, alongside a substantial body of research spanning liver and pancreatic disease. He was appointed Professor of HPB Surgery at the University of Manchester in 2008 and was recognised with the Silver Scalpel award for surgical training in 2007. His career has also included significant contributions to surgical research, education and international HPB collaboration, and he currently serves as Past President of the E-AHPBA. References: Braganza J, Lee S, McCloy R et al. Chronic pancreatitis, The Lancet, 2011; 377, 1184-1197 Siriwardena AK, Mason JM, Balachandra S, Bagul A, Galloway S, Formela L, Hardman JG, Jamdar S. Randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis. Gut. 2007 Oct;56(10):1439-44. doi: 10.1136/gut.2006.115873. Epub 2007 Mar 13. PMID: 17356040; PMCID: PMC2000286. Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology. 2009 Jan;136(1):149-159.e2. doi: 10.1053/j.gastro.2008.09.028. Epub 2008 Sep 25. PMID: 18952082. Siriwardena AK, Windsor J, Zyromski N, Marchegiani G, Radenkovic D, Morgan C, Passas I, Olah A, Conlon KC, Smith M, Busch O, Baltatzis M, Besselink MG, Vollmer C, Castillo CF, Friess H, Garcea G, Burmeister S, Hackert T, Lillemoe KD, Schulick R, Shrikhande SV, Smith A, Gianotti L, Falconi M, Adams D, Adham M, Andersson R, Del Chiaro M, Devar J, Jegatheeswaran S, van Santvoort H, Khatkov I, Izbicki J, Büchler M, Neoptolemos JP, Bassi C, Dervenis C. Standards for reporting on surgery for chronic pancreatitis: a report from the International Study Group for Pancreatic Surgery (ISGPS). Surgery. 2020 Jul;168(1):101-105. doi: 10.1016/j.surg.2020.02.007. Epub 2020 Mar 14. PMID: 32183994. van Veldhuisen CL, Kempeneers MA, de Rijk FEM, et al. Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial. JAMA Surg. 2025;160(2):126–133. doi:10.1001/jamasurg.2024.5182 Di Sebastiano P, di Mola FF, Buchler MW, Friess H. Pathogenesis of pain in chronic pancreatitis. Dig Dis. 2004;22(3):267-72. doi: 10.1159/000082798. PMID: 15753609. Izbicki JR, Bloechle C, Broering DC, Kuechler T, Broelsch CE. Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure. Ann Surg. 1998 Feb;227(2):213-9. doi: 10.1097/00000658-199802000-00010. PMID: 9488519; PMCID: PMC1191238.