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The purpose of the study was to present the clinical outcomes of a novel procedure in severe chronic pancreatitis complicated by uncontrollable pain and vascular involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We describe an in situ near-total pancreatectomy that avoids peripancreatic vascular dissection (Livocado procedure) and report on surgical and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The Livocado procedure was carried out on 18 (3.9%) of 465 patients undergoing surgery for chronic pancreatitis. There were 13 men and 5 women with a median (IQR) age of 48.5 (42.4\u201357) years and weight of 60.7 (58.0\u201375.0) kg. All had severe pain and vascular involvement; 17 had pancreatic parenchymal calcification; the median (IQR) oral morphine equivalent dose requirement was 86 (33\u2013195) mg\/day. The median (IQR) maximal pain scores were 9 (9\u201310); the average pain score was 6 (IQR 4\u20137). There was no peri-operative or 90-day mortality. At a median (IQR) follow-up of 32.5 (21\u201345.75) months, both maximal and average pain scores were significantly improved post-operatively, and at 12\u00a0months, two-thirds of patients were completely pain free. Six (33%) patients had employment pre-operatively versus 13 (72%) post-operatively (<jats:italic>p<\/jats:italic>\u2009=\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Livocado procedure was safe and carried out successfully in patients with chronic pancreatitis with vascular involvement where other procedures would be contraindicated. Perioperative outcomes, post-operative pain scores, and employment rehabilitation were comparable with other procedures carried out in patients without vascular involvement.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00423-021-02107-x","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T02:02:26Z","timestamp":1624586546000},"page":"2657-2668","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The in situ near-total pancreatectomy (LIVOCADO procedure) for end-staged chronic pancreatitis"],"prefix":"10.1007","volume":"406","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3194-6689","authenticated-orcid":false,"given":"Ryan D.","family":"Baron","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4980-956X","authenticated-orcid":false,"given":"Andrea R. 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All other authors declare no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}