Introduction: Surgeons are often biased for choosing either the parenchymal preserving surgery (PPS) or the total pancreatectomy with autologous islet cell transplant (TPAIT) for chronic or recurrent pancreatitis (CP), depending on their personal beliefs and the availability of the islet isolation facilities. Aim is to evaluate the outcomes of both PPS and TPAIT at a single center having capacity to offer both surgeries. Methods: 152 patients with CP were evaluated between September 2017 to 2019; 32 were offered surgery based on the algorithm in Figure 1. Each surgery was performed by a single surgeon, alleviating potential bias due to surgeon preference or technical expertise. Quality of life (QOL), glycemic control, and reduction in narcotic use was evaluated in each patient. Outcomes were compared using Pearson's c2 test, student's t-test, and Kruskal-Wallis rank test. Results: Post-operatively 100% of TPAIT patients and 93.3% of PPS patients reported great improvement in QOL by 3 months (p=0.3). At 2 months only 7 (63.6%) of TPAIT and 6 (60.0%) of PPS patients required narcotics. All PPS patients weaned off narcotics by 3 months; however, 1 TPAIT patient continued to require narcotics at 1 year. Endocrine variables are shown in Table 1. 4 (28.6%) of TPAIT patients completely insulin independent. No hypoglycemic morbidity-mortality occurred. Conclusion: While TPAIT patients may have insulin requirement post-operatively, overall outcomes are comparable. In patients with non-localized disease, advantages of TPAIT in terms of preventing pain, pancreatic cancer and avoiding hypoglycemic complication cannot be overlooked when compared with PPS surgery.Table 1.Endocrine outcomes following TPAIT vs. PPSTPAITPPSp-valueAll patients Insulin dependent, n (%)At 3 months9 (75.0)2 (33.3)0.09At 1 year4 (100)2 (66.7)0.2Pre-operatively diabetic/pre-diabetic insulin dependent, n (%)At 3 months6 (100)2 (66.7)0.1At 1 year2 (100)2 (66.7)0.8Pre-operatively non-diabetic insulin dependent, n (%)At 3 months3 (50.0)0 (0)0.1At 1 year2 (100)NRNA Open table in a new tab