Role of biliary diversion in addition to head coring in case of CCP with head mass and biliary stricture

Abstract

Introduction: Biliary strictures as a consequence of Chronic pancreatitis(CP) have long been recognized. Clinical presentation of biliary stricture varies from an incidental finding to overt jaundice and cholangitis. Head coring is the recommended treatment in a subset of patients with head mass who develop biliary symptoms. Aim: We want to report on our experience regarding surgical management in CP with head mass and benign biliary stricture. Method: Observational study (Retrospective - prospective study). Results: Over a period of 3 years, we have managed 80 cases of CP at our institution by surgical intervention. Presenting symptoms, laboratory findings with radio-imaging, operative procedures and follow-up parameters of these patients were collected from our prospective database. Total 21 (26%) patients had biliary obstruction in the background of CP, out of which 15 (19%) patients had a mass lesion in head of pancreas. The most commonly performed operation was Frey's procedure with Choledocho-jejunostomy in 6(40%) patients, while other procedure were Choledocho-duodenostomy in 4(27%), Hepatico-jejunostomy in 1(7%), Cholecysto-jejunostomy in 1(7%), Cholecystectomy in 2(13%) and 1(7%) patient with hard head mass with regional lymphadenopathy had undergone Whipple's procedure. Two patients came with recurrent biliary stricture after 3 years of Frey's Procedure with cholecytectomy, underwent Choledocho-jejunostomy. Conclusion: Biliary diversion is still the best option for CP with head mass and benign biliary stricture in addition to Frey's procedure, since head coring alone is not an adequate operation in the management of biliary obstruction in CCP with head mass.