Surgical treatment of paraduodenal pancreatitis

Abstract

Background: Cystic inflammatory transformation of duodenal wall described as a "paraduodenal pancreatitis" (PP). We evaluated the clinical efficacy of the surgical treatment of PP Methods: 90 patients with PP were retrospectively included over 12 years. Initially, all patients received conservative therapy. 80 patients required surgical treatment after conservative treatment with a median duration of 2 years. 37 patients underwent pancreaticoduodenectomy (PD), 21 -duodenum resection, 18 – duodenum-preserving pancreatic head resection (DPPHR), 4 - palliative operations. 10 non-operated patients remained under observation. 4 of them required various palliative endoscopic procedures.Long-term results were evaluated in 50 patients, the median follow-up was 47 months Results: PP was associated with chronic pancreatitis (CP) in 93%. Clinical course of PP consisted of the typical symptoms of CP: abdominal pain in 98.8% of patients, body weight loss - 65.5%, duodenal obstruction - 64%, biliary hypertension - 36%. The overall postoperative morbidity was 33.8%, mortality - 1.25%. After surgical treatment 66% of patients had no clinical symptoms, 32% - significant improvement and no clinical effect was in 2 % Conclusion: Typically PP occurs in patients with CP. The treatment of patients with PP should starts from conservative therapy. Surgery is indicated for patients with a persistent abdominal pain and a presence of a CP complications. Procedures of choice are PD and DPPHR