Background: Chronic pancreatitis is a debilitating condition with multiple causes, including alcohol abuse, genetic mutations, and recurrent episodes of acute pancreatitis. It can progress to severe abdominal pain, reduced endocrine/exocrine function, and increased risk of malignancy. Histopathological changes include glandular destruction and fibrosis from chronic inflammation. Surgical interventions are classified into resection or drainage procedures which are often preferred for their parenchymal preservation. Classic resections (pancreatoduodenectomy and distal pancreatectomy) are selected when the dominant site of disease is either the head or tail of the gland. Total pancreatectomy with islet cell autotransplantation (TPIAT), discussed elsewhere, is emerging as a potential early intervention. However, it is currently limited to highly specialized centers, so the classic resection procedures remain relevant today. Indications for Resection: Head-dominant disease typically requires pancreatoduodenectomy, while tail-dominant disease may necessitate distal pancreatectomy. Surgery is indicated for pain relief, pancreatic function preservation, or concern for malignancy. Perioperative Management: Preoperative evaluation assesses pain history, opioid use, alcohol cessation, genetics, and nutrition. Workup includes lab work, high-quality axial imaging, and advanced endoscopy. Surgery aims to reduce opioid reliance, halt parenchymal destruction, and in some cases rule out malignancy. Pitfalls and Pearls: Surgery for chronic pancreatitis is complex due to chronically inflamed and phlegmonous tissue planes and complications are common. Understanding the imaging characteristics is critical to selecting the correct operation and must be tailored to the individual patient’s site of disease. For the subset of patients where resection is appropriate, surgery can alleviate pain, preserve pancreatic function, and improve quality of life.