Duodenum-preserving surgical approach to the treatment of paraduodenal pancreatitis

Abstract

Introduction: Paraduodenal pancreatitis (PDP) is an uncommon form of chronic pancreatitis. To date, no consensus exists regarding surgical timing and technique for the treatment of PDP. The aim of our study was to investigate the role of duodenum-preserving pancreatic head resections (DPPHR) in the treatment of PDP. Methods: Retrospective analysis of the 1409 patients with chronic pancreatitis treated in our clinic from 2015 to 2019 was performed, out of which 112 patients with PDP were identified. Results of the treatment of patients who required DPPHR were analyzed. Such modifications of DPPHR as Berne`s, Beger`s and Frey`s procedures were used depending on the extent of the inflammation and anatomical variations. Pain was assessed preoperatively and at 18 months after surgery using visual analogue pain scores (VAS) and results were converted to values from 0 to 100. Results: A total of 45 DPPHR were performed. Mean duration of operative procedure was 144 min with mean blood loss of 122 ml. Hospital length of stay was 14,2 ± 1,5 (95% CI) days and complication rate was 11,1%. No mortality was recorded. Preoperative and postoperative VAS results for pain were 86 and 17 respectfully. Conclusion: DPPHR is safe (complication rate 11,1%) procedure for the treatment of paraduodenal pancreatitis. It achieved good results in terms of pain control at 18 months after surgery with the results of VAS pain assessment dropping from 86 to 17.