OBSTRUCTION OF BILE DUCTS IN CHRONIC PANCREATITIS AND POSSIBILITIES OF ITS SURGICAL CORRECTION

Abstract

Purpose of the study: optimize surgical tactics for bile duct obstruction in patients with various forms of chronic pancreatitis (CP). Materials and methods: The results of the examination and treatment of 503 patients with CP, 354 of whom were operated on, were analyzed. Mechanical jaundice was detected in 76 (21.5%) patients. The main type of relief of symptoms of biliary tract obstruction were transpapillary endoscopic and laparoscopic techniques or their combinations, which in 37 (47.4%) patients were the final treatment option, and in 35 (46.1%) - a preliminary stage before performing traditional surgical interventions. Traditional interventions were the only treatment method in 4 (6.4%) patients. Results: Based on the modified Marseille-Rome classification of CP (1988), a systematic approach was developed to assist this category of patients. It has been established that the use of endoscopic techniques in patients with obstructive CP allows not only to stop the symptoms of biliary hypertension, but also to influence the course of the underlying disease, by ensuring adequate drainage of both the bile and pancreatic ducts. The use of transduodenal and laparoscopic techniques for the relief of obstructive jaundice in patients with inflammatory CP, calcifying CP is best justified as a preliminary stage of treatment. The preferred option of surgical correction in patients with inflammatory and calcific CP with primary lesions of the pancreas head should be resection of the pancreas head according to Beger or Frey. Conclusion: The optimal combination of minimally invasive surgical treatment options and traditional surgical interventions, taking into account the shape and variation of CP, complicated by the development of obstructive jaundice, allows for maximum correction of the course of the disease in the near term and in the long term.