Surgical management of biliary strictures due to chronic pancreatitis: a prospective non-randomized study

Abstract

Introduction: Biliary stricture (BS) has been increasingly recognized as complication of chronic pancreatitis (CP). The aim of this single-center non-randomized prospective study was to analyze and compare results of different types of biliary reconstruction during carried out local resection of the head of the pancreas. Methods: Forty nine patients were included in this study. The common bile duct was widely opened into resulting cavity after pancreatic head resection and Roux-en-Y jejunal limb was included to drain BS in 21 cases (group“1”). Choledochojejunostomy with Roux-en-Y anastomosis has been performed at 28 patients (group“2”). Early postoperative morbidity and mortality were evaluated in both groups. Quality of life was measured prospectively before surgery and during follow-up (12 and 36 months) using the MOS SF-36 v.2тм. Results: The overall surgical morbidity was significantly higher in the “1”-group (χ2 = 6,504, df = 1, p = 0,011). Mortality - only one case in group“1” (χ2 = 3,200, df = 1, р = 0,783). There was an average communication between biliary reconstruction and frequency of relapse of symptoms and progressions CP after operation group's “1”/“2” (Fisher exact р = 0,014). Total pain score decreased and quality of life increased significantly after surgery in both groups after 12 months and were not significant to increase during 36 months follow up. Conclusion: Both surgical procedures led to significant improvement in the quality of life and pain relief after surgical BS reconstruction due to CP. Under equal conditions, the preference should be given to choledochojejunostomy with Roux-en-Y anastomosis because has better shot-term results.