© 2015 by John Wiley & Sons, Ltd. All rights reserved. There is no standard of therapy for chronic pancreatitis, and it can be managed with multiple combinations of modalities. Several different types of operative treatment are used typically when other modalities fail. The goal of operative intervention is removal of the nidus of disease and/or drainage of the pancreatic duct in order to improve quality of life by relieving pain. Major resections include pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy. Of particular concern for patients with chronic pancreatitis is the diabetes that can be precipitated by resection. Islet-cell autotransplantation has shown promise in ameliorating the natural history of the diabetes after pancreatectomy in chronic pancreatitis. Operative intervention for chronic pancreatitis should be performed by experienced surgeons at high-volume institutions to provide the most favorable outcomes and follow-up.