Abstract
Surgical treatment was applied in 145 patients with complicated forms of chronic pancreatitis (CP) at the department of surgery of the Ivano-Frankivsk Regional Clinical Hospital in 2009–2016. Fourty-nine (33.7 %) patients had symptoms of biliary hypertension (BH); in five (3.4 %) of them BH was combined with chronic duodenal obstruction (CDO), the other 5 (3.4 %) patients had a combination of BH+CDP and local venous hypertension of pancreaticobiliary area vessels. Resection-type surgeries were applied in 28 (57.1 %) patients with CP complicated by BH. Intraoperative monitoring of biliary pressure was used in 17 patients in the process of duodenum-preserving resections of the pancreas. Frey’s procedure was applied to 20 (71.4 %) patients, in whom BH persisted after the resection stage of the surgery; Frey’s procedure was supplemented by interventions on bile ducts: hepaticoenteroanastomosis was applied in 12 patients, excision of pancreas lingula was applied in one patient, internal biliopancreatic anastomosis was applied in one patient. Berne modification was used in 2 (7.2 %) patients, and pancreaticoduodenal resection (PDR) according to Whipple – in 6 (21.4 %) patients. Remote results were studied in 19 (67.8 %) patients. Patients after duodenum-preserving resections had the best quality of life indicators, for BH signs were absent.
Highlights
Surgical treatment of chronic pancreatitis (CP) is a topical, complicated and not completely resolved problem of gastroenterology
Patients with CP complicated by biliary hypertension (BH) underwent resection, draining and palliative surgeries
Resection surgeries included: pancreaticoduodenal resection (PDR), pylorus-preserving PDR, Beger’s procedure, Frey’s procedure, longitudinal pancreaticoenterostomy (LPES) with artificial duct formation, Berne modification A manifest chronic inflammatory process in the area of the pancreas was the indication to resection interventions
Summary
Surgical treatment of CP is a topical, complicated and not completely resolved problem of gastroenterology. Indications to surgical treatment of CP are not always specific. Surgical treatment is indicated in case of clinical signs of CP and morphological changes in the pancreas when conservative therapy is ineffective and there is a threat of CP complications or the complications have already occurred [1]. The task of surgical treatment of CP include: elimination of pain and local complications, preservation and improvement of exocrine and endocrine functions of the pancreas, improvement of the patients’ quality of life [12,13,14,15,16]
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