Surgical Treatment Of Chronic Pancreatitis Research Articles

Surgical treatment of chronic pancreatitis in children

Chronic pancreatitis in children is a continuous or recurrent disease characterized by irreversible inflammatory and destructive changes in the pancreas (PG), progressive fibrosis, accompanied by a gradual decrease in its exocrine and endocrine functions. In recent decades, there has been a significant increase in patients with CP; the incidence in children is estimated at 2 cases per 100,000 people. According to the literature, pancreatic cancer in the outcome of chronic pancreatitis in childhood is 6.2%. Mortality rates for CP vary in different studies: 15-20% of children with CP die from complications and secondary disorders. The purpose of the study is to study current problems and determine the prospects for the treatment of chronic pancreatitis in children based on a review of modern literature. Materials and methods. As part of the preparation, a systematic review of the world and domestic literature on the surgical treatment of chronic pancreatitis in children was carried out. Results. A literature search confirmed the lack of consensus regarding the surgical treatment of CP in children. The small number of observations does not allow us to analyze the long-term results of surgical treatment of children with CP. Patients with hereditary pancreatitis pose a particular challenge; treatment algorithms for this group of patients are not described in the literature. Also in the literature there are isolated descriptions of complications with CP in children; there are no reliable results of the effectiveness of surgical intervention for endocrine and exocrine insufficiency in children. It is necessary to conduct scientific and practical research to develop indications for surgical treatment of children with CP and to verify specific complications.

Surgical treament of chronic pancreatitis (literature review)

Target. To summarize the available literature data on the methods of surgical treatment of chronic pancreatitis, evaluate their results, identify shortcomings and possible solutions.Materials and Methods. We conducted a literature review of scientific papers over the past 20 years, using the resources of the search engines PubMed, Cyberleninka and eLIBRARY, on the available methods of surgical treatment of chronic pancreatitis. For this meta-analysis, we used articles containing an evidence-based experimental and clinical base on issues related to long-term and immediate results of surgical treatment.Results and discussion. We analyzed the immediate and long-term results of the methods of surgical treatment of chronic pancreatitis. In almost all studies, resection-drainage methods made it possible to effectively stop the pain syndrome for a long time. However, exoand endocrine insufficiency in most cases persisted or progressed, regardless of the method used. Another disadvantage of the existing methods was the inability to stop bleeding from the area of pancreatojejunostomy in the early postoperative period, so mortality after the development of these complications ranged from 5 to 60%.Conclusion. Based on the results studied, we identified the following disadvantages of the known methods of surgical treatment of chronic pancreatitis: 1. A long loop of the small intestine, at least 70 cm, turned off from digestion, leading to a significant decrease in the length of the intestinal tube, and, accordingly, the area of absorption of food nutrients. 2. The features of the reconstructive stage of the operation do not provide the physiological flow of pancreatic secretion into the duodenum and, accordingly, the activation of enzymes, thereby turning off the duodenal phase of digestion. 3. Roux-enabled loop of the small intestine creates favorable conditions for the development of excessive bacterial growth. 4. Lack of endoscopic evaluation of the pancreas to stop bleeding in the early postoperative period. After analyzing the literature data, we came to the conclusion that the elimination of these shortcomings will improve the results of chronic pancreatitis treatment.

ХИРУРГИЧЕСКАЯ ТАКТИКА И ПРОГНОЗИРОВАНИЕ РАННИХ ПОСЛЕОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ ПОСЛЕ ПРОКСИМАЛЬНОЙ РЕЗЕКЦИИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ ПРИ ХРОНИЧЕСКОМ ПАНКРЕАТИТЕ

Background. The advances in surgical treatment of chronic pancreatitis (CP) have significantly reduced postoperative mortality rate, however, the number of deaths remains high. Thus, prevention and prediction of complications are regarded as a complex and important task in choosing optimal surgical strategy. Objective. To study early postoperative complications after proximal pancreatic resection in chronic pancreatitis; to determine surgical strategy in preoperative and postoperative stages to reduce the risk of and predict postoperative complications. Material and methods. From 2001 to 2019 on the basis of the Vitebsk Regional Clinical Hospital, 246 patients with CP and its complications were operated on, among them there were 223 (90.7%) men and 23 (9.3%) women. The mean age was 48(±6) years. Our study did not include patients who underwent Frey's operation and pancreatoduodenal resection due to their small number. Results. Of 246 operated patients, early postoperative complications occurred in 126 (51.2%) patients. Among them after the Beger’s operation - in 77 (31.2%) patients, after the Berne modification of the Beger’s operation - in 49 (20%) patients, respectively. Of the 126 patients with developed postoperative complications, repeated surgical interventions were performed in 50 (39.7%) patients - 35 (70%) patients after the Beger’s operation and 15 (30%) patients after the Berne modification of the Beger’s operation, respectively; in 76 (60, 3%) patients, postoperative complications were controlled by conservative measures. In order to manage early postoperative complications, various types of surgical interventions were performed. Conclusions. Patients with pancreatic calcification, virsungectasia, virsungolithiasis in combination with portal hypertension are more likely to develop early postoperative complications during the Beger’s operation, in comparison with the Berne modification of the Beger’s operation. In patients with pancreatic calcification, virsungectasia and virsungolithiasis in combination with portal hypertension, as well as in patients with pancreatic head cysts, it is advisable to perform the Berne modification of the Beger’s operation, it being technically simpler thus allowing to minimize the number of postoperative complications. When performing the Beger’s operation, as compared to the Berne modification of the Beger’s operation, there were no statistically significant differences in the total number of repeated interventions aimed to correct early postoperative complications, however, after the Beger’s operation, the complications were statistically significantly more often managed by minimally invasive intervention (p=0.005).

Comparative Study of Different Types of Pancreatic Head Resection for Chronic Pancreatitis

For the surgical treatment of chronic pancreatitis with inflammatory head enlargement, several types of resections are available, like the Beger, Frey, Berne, and Whipple procedures. The present work gives a comparison of these techniques and new recommendations about the pancreatojejunal and the biliary anastomosis. Two hundred thirty pancreatic head resections were performed during the last 30 years. Pre-, intra-, and postoperative data were analyzed, respectively. A questionnaire was used to investigate the late results. The statistical analysis proved that the Berne and the Frey procedure were the most advantageous regarding the length of the operation, the need for transfusion, the postoperative intensive care unit, and total hospital stay. The early morbidity rate was significantly better after the Frey, than after the Whipple procedure. There were no differences between the operations, concerning the reoperation and mortality rates. Patients’ quality of life was acceptable, despite the continuous alcohol and nicotine abuse in most of them. Due to the better early outcomes, both the Frey and the Berne operations are preferable; however, the latter one is technically the simplest and the shortest intervention. During both procedures, a modification of the pancreatojejunal anastomosis and, in case of a cholestasis, an extrapancreatic biliodigestive anastomosis are recommended, due to the advantageous experiences.

Academician Nikolay Anatolyevich Maistrenko (to the 70th anniversary of his birthday)

Nikolay Anatolyevich Maistrenko is a prominent specialist in the field of abdominal and endocrine surgery, oncology, and organization of specialized surgical care. For 24 years, he headed the Department and Clinic of Faculty Surgery named after S.P. Fedorov Military Medical Academy of S.M. Kirov. With his direct participation in the clinic, the structural units became modernized, which were equipped with modern equipment to provide high-tech surgical care. Under the direction of Academician of the Russian Academy of Sciences N.A. Maistrenko, the range of scientific research conducted in the clinic and together with other research institutions of Saint Petersburg (i.e., Research Institute of Oncology named after N.N. Petrov, Institute of Physiology named after I.P. Pavlov, and Research Institute of Emergency Medicine named after I.I. Dzhanelidze) has significantly expanded. The main areas of scientific activity of Professor N.A. Maistrenko are the development of organizational, tactical, and technical issues of providing surgical care to patients with gastroenterological profile; study of long-term results of organ-preserving operations and resection interventions for complicated gastric and duodenal ulcers; research on the problem of choledocholithiasis using laparoscopic, endoscopic, and non-surgical methods of its elimination; introduction of new diagnostic and therapeutic technologies in surgical endocrinology; study of the possibilities of laparoscopic interventions in emergency surgery of acute diseases and abdominal organ injuries; development of topical aspects of colorectal surgery using new technologies when performing sphincter-preserving operations; and surgical treatment of chronic pancreatitis. Academician N.A. Maistrenko is the author and co-author of more than 750 scientific papers, including 28 monographs and manuals. Under his direction, 13 doctoral and 19 masters theses were defended. Eighteen teaching aids, workshops, and lectures have been published on various sections of endocrine and abdominal surgery. Nikolay Anatolyevich Maistrenko is a vivid example of how aspiration, diligence, and discipline ensure the achievement of the highest goals, and love for his specialty guarantees great professional success.

Nationwide Trends in Use and Outcome of Surgical Treatment in Chronic Pancreatitis

Nationwide Trends in Use and Outcome of Surgical Treatment in Chronic Pancreatitis

Wirsungectomy for pancreatic hypertension in chronic pancreatitis

Background. Pain in chronic pancreatitis (CP) can occur as a consequence of mechanical factors— pancreatic ductal hypertension, interstitial pressure, inflammatory and neuropathic pathological changes in the pancreas. The purpose was to evaluate a novel modification of the classic Partington-Rochelle procedure via comparing functional results of conventional surgery group and wirsungectomy group. Materials and methods. A retrospective analysis of the case histories of patients with CP and an enlarged (≥4mm) main pancreatic duct was carried out for the period from 2003 to 2009, which underwent surgical treatment of CP. The SF-36 and EORTC QLQ-C30 questionnaires, and visual analogue scale of pain were used for the assessment. The first group included five patients with wirsungectomy with lateral pancreaticojejunostomy (PEA + WE); the second group consisted of 20 patients after the lateral pancreaticojejunostomy (PEA) only. Cross-tabulation analyses were performed to compare PEA and PEA + WE groups as well as those groups in different time points using a two-sided Student’s t-test. The significance level was set to p<0.05. Results. The groups were compared in terms of VAS and the EORTC QLQ-C30 questionnaire before and 2 years after surgery using Student’s t-test for unrelated values: statistically significant differences between the groups according to VAS as before (p=0.757) and after surgery (p=0.696) were not obtained. There were no significant differences (p > 0.05) between the PEA and PEA + WE groups before and after surgery according to the EORTC QLQ-C30 questionnaires, except for some items (p<0.05) Within the groups according to VAS and EORTC QLQ-C30 (pain severity), in the PEA group (p=0.000001, p=0.000109) and the PEA + WE group (p=0.018, p=0.017) after surgery, there was a statistically significant decrease in pain. Conclusions. Longitudinal pancreaticojejunostomy with wirsungectomy is justified in patients with long-term CP, severe fibrosis of the pancreas with multiple calcifications of the periphery pancreatic ducts to decompress pancreatic ducts, and parenchyma. In the long-term period after 2 years, the proposed method of longitudinal pancreaticojejunostomy with wirsungectomy in patients with CP with dilation of main pancreatic duct according to the VAS scale and EORTC QLQ questionnaires C30 and SF-36 is accompanied by a significant reduction in pain.

Optimal time for surgical treatment of chronic pancreatitis or optimal surgery?

Background. The majority of studies on the surgical treatment of chronic pancreatitis (CP) compare treatment outcomes by the type of the procedure. However, some studies, especially systematic reviews and meta-analyses, indicate the equality of different surgeries by their long-term results. During last 5–9 years, several studies showed advantages of early surgery in chronic pancreatitis, within three years after symptoms onset. Objective: to analyze the short- and long-term results of surgical treatment for chronic pancreatitis regarding timing and, accordingly, the neglect of the disease. Materials and methods. Retrospective analysis of data of 147 patients from 2001 to 2020, the main intervention was surgery aimed at the main manifestations of CP, such as pancreatic ductal and/or parenchymal hypertension. Patients who suffered from CP symptoms 3 years or more were included in the control group (late surgery), and those who noted symptoms of CP for less than 3 years were included in the study group (early surgery). All patients completed the EORTC QLQ-30, SF-36 questionnaires, as well as the questionnaire developed by the study authors, via telephone or mail, or during the visit. Results. According to all scales of the SF-36 questionnaire, except for Physical functioning, the group of early surgery prevails over the group of late surgery. The early surgery group had the best average scores on all functional scales of the EORTC QLQ-30 questionnaire compared to the late surgery group, except for the Cognitive functioning. Of the symptomatic scales, the early surgery group had the best averages on Pain and Diarrhea. The average Health/Quality of life scale was significantly better in the early surgery group. Conclusions. The quality of life, pain control, pancreatic function in patients operated within 3 years from the onset of CP symptoms were better compared to those with longer disease duration, with the same short-term results. The duration of the disease is a major factor for the success of surgical treatment of chronic pancreatitis in terms of long-term results. The early surgery is effective approach to obtain better long-term outcomes in chronic pancreatitis.

Surgical treatment of chronic pancreatitis: indications, timing, methods

The review is devoted to complex treatment of chronic pancreatitis considering modern data on pathogenesis of this disease. The authors analyze various aspects of endoscopic and surgical interventions in refractory pain syndrome and complications of chronic pancreatitis, as well as positive and negative aspects of each method. Various surgical interventions and indications are analyzed in detail. One of the important points was analysis of the period between disease onset and surgical treatment that affects quality of life in patients with chronic pancreatitis in mid- and long-term period.

Optimal management of early surgery of chronic pancreatitis

The aim of the present research is to investigate whether there are advantages of early surgical treatment or not, especially for pain relief. Retrospective analysis of data of 147 patients from 2001 to 2020 was conducted, which underwent surgical treatment of chronic pancreatitis. Patients who had been suffering from chronic pancreatitis symptoms for 3 years or more were included in the control group (“late surgical treatment”), and patients who had been noting symptoms of chronic pancreatitis less than 3 years were included in the study group (“early surgical treatment”). All patients completed the EORTC QLQ-30, SF-36 questionnaires, as well as the questionnaire developed by the research authors, via telephone or mail or during the visit. According to all scales of the SF 36 questionnaire, except for “Physical functioning”, the group of “Early surgical treatment” prevails over the group of “Late surgical treatment”. The “Early surgical treatment” group had the best average scores on all functional scales of the EORTC QLQ-30 questionnaire compared to the “Late surgical treatment” group, except for the Cognitive Functioning scale. From the symptomatic scales, the “Early surgical treatment” group had the best averages of Pain and Diarrhoea.

Conservative or surgical treatment of chronic pancreatitis?

The cardinal symptom of chronic pancreatitis is severe belt-like upper abdominal pain, which requires immediate and adequate treatment. Furthermore, advanced stage chronic pancreatitis is often associated with complications, such as pancreatic pseudocysts, pancreatic duct stones and stenosis as well as biliary stenosis. The various endoscopic and surgical treatment options for chronic pancreatitis patients have been controversially discussed for decades. The new German S3guidelines on pancreatitis now clearly define the best treatment options depending on the indications for treatment. For the treatment of pain in chronic pancreatitis it has been known for a long time that a surgical intervention is superior to endoscopic intervention concerning long-term pain relief. The recently published ESCAPE study has further underlined this by showing that early surgical intervention was superior to astep-up approach with initial endoscopic treatment. For the treatment of pancreatic pain, an initial endoscopic treatment attempt is therefore justified for short-term pain relief but in the midterm and long term, surgical intervention is the treatment of choice. In contrast, pancreatic pseudocysts, solitary proximally situated pancreatic duct stones and benign biliary strictures (except in calcifying pancreatitis) can nowadays generally be managed endoscopically. For distal pancreatic duct stones and symptomatic pancreatic duct stenosis surgical treatment is again the method of choice. This review article discusses these indication-related procedures in detail and explains them in relation to the recently published S3guidelines on pancreatitis of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS).

ДУОДЕНУМ-СОХРАНЯЮЩАЯ РЕЗЕКЦИЯ ГОЛОВКИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ ПРИ ХРОНИЧЕСКОМ ПАНКРЕАТИТЕ, ДОБРОКАЧЕСТВЕННЫХ И ПРЕДРАКОВЫХ ОПУХОЛЯХ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ

Objective. To report the institutional experience of the evolution of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for chronic pancreatitis with an inflammatory tumor as well as cystic and benign, premalignant neoplasms and neuroendocrine tumors of the pancreatic head. Methods. DPPHR is associated with preservation of gastric antrum, common bile duct and duodenum/upper jejunal loop, contrary to Kausch-Whipple resection, which is a multivisceral procedure, including duodenectomy. Duodenum-preserving pancreatic head resection was first established in clinical setting in Berlin in 1969. Results. For chronic pancreatitis with an inflammatory infiltrat in the pancreatic head, duodenum-preserving pancreatic head resection has become a standard surgical treatment with worldwide acceptance. In a series of 603 patients with chronic pancreatitis following DPPHR, the frequency of pancreatic fistula was 3.3 %, intra-abdominal abscess 2.8 %, hemorrhage 2.8 %, frequency of reoperation 5.6%, in-hospital mortality 0.82 % and 90-day rehospitalisation 8 %. DPPHR for benign and premalignant cystic neoplasms of the pancreatic head is used predominantly for IPMN, MCN and SPN tumors. In a review of international publications comprising 503 patients, the general morbidity was 38.2 %, severe surgery-related complications 12.7% of them pancreatic fistula B+C 13.6 %, resurgery 2.7 % and 90-day mortality 0.4 %. When pancreatic neuroendocrine tumors of pancreatic head are treated with DPPHR, a local lymph node dissection is additionally recommended. The long-term morbidity following DPPHR revealed new onset of diabetes mellitus and exocrine dysfunctions in only 5-7 % of patients. Conclusion. Kausch-Whipple resection is associated with considerable high metabolic complications. Duodenum-sparing pancreatic head resection for inflammatory tumor, benign and premalignant neoplasms, and neuroendocrine tumors of the pancreatic head has the advantage of the duodenum preservation and maintenance of the pancreatic endocrine and exocrine functions.

Laparoscopic versus open surgical management of patients with chronic pancreatitis: Amatched case-control study.

Background:The safety and feasibility of laparoscopic surgery in patients with chronic pancreatitis (CP) have been established, but its outcome has not been compared to that of open surgery.Patients and Methods:This retrospective study was conducted on patients with CP who were treated by a single surgical team from 2012 to 2018. The medical records of patients with surgical treatment of CP were reviewed. Patients were divided into laparoscopic group (LG) and open group (OG). Both the groups were matched for age and procedures. The matched groups were compared.Results:The total number of unmatched patients was 99 and post matching, there were 38 patients in each group. The demographic, aetiological, clinical and laboratory parameters were comparable. The number of each surgical procedure including bilio-enteric anastomosis was also similar. Lateral pancreaticojejunostomy was the most common surgical procedure in both the groups. An additional surgical procedure (bilio-enteric bypass) was required in 10.5% of the patients in LG and 21% of the patients in OG groups (P = 0.3). Significantly lower blood loss (100 vs. 120 ml) and higher operation time (300 vs. 210 min) were observed in LG. The post-operative complication rate was 7.9% in LG group versus 10.5% in OG group. More than 85% of the patients in both the groups had a significant relief from pain. The impact of exocrine and endocrine insufficiency was not remarkable in both the groups. The requirement of an additional surgical procedure was associated with a high conversion rate.Conclusions:The outcomes of laparoscopic surgery in patients with CP were similar to that of open surgery, and requirement of an additional surgical procedure is associated with a high conversion rate.

A hybrid approach for chronic pancreatitis: combination of laparoscopic assisted distal pancreatectomy and open Frey procedure

BackgroundThe treatment of chronic pancreatitis requires a surgical approach in patients who are refractory to medical therapy. During surgical treatment, ductal decompression is required, but a pancreatectomy is necessary for some patients, such as those with severe stenosis of the pancreatic duct. Indeed, suboptimal procedures lead to recurrent pancreatitis. We used a laparoscopic hybrid approach for patients with severe stenosis of the pancreatic duct. In this report, we present the feasibility and outcomes of our approach.MethodsWe selected a laparoscopic approach for the distal pancreatectomy, which is relatively safe and the effect of reducing the length of the wound is substantial. We selected an open approach for the Frey procedure because complete ductal compression has a high risk for injury to the vessels posterior to the pancreas. We recorded the operative outcomes, postoperative complications, and recurrence of pancreatitis.ResultsWe performed the laparoscopic hybrid approach on 3patients between January and December 2018. There were no major intraoperative complications (Clavien-Dindo classification IIIa or more) and the postoperative course was uneventful in all patients. There were no recurrences of pancreatitis and no postoperative pain in all patients in > 2 years of follow-up.ConclusionOur hybrid method with a focus on complete ductal compression with safety and minimal invasiveness might be the optimal approach for the surgical treatment of chronic pancreatitis that requires a pancreatectomy with the Frey procedure.

Surgical treatment of chronic pancreatitis:indication and timing

Surgical treatment of chronic pancreatitis:indication and timing

РЕНТГЕНЭНДОВАСКУЛЯРНАЯ ЭМБОЛИЗАЦИЯ СОСУДОВ ПАРАПАНКРЕАТИЧЕСКОЙ ЗОНЫ В ЛЕЧЕНИИ ОСЛОЖНЕНИЙ ХРОНИЧЕСКОГО ПАНКРЕАТИТА

Goal. To improve the results of surgical treatment of chronic pancreatitis complicated by vascular pathology of the parapancreatic zone. Materials and methods. On the basis of the "Grodno University Clinic" in the department of X-ray Endovascular Surgery of the period 2010 to April 2020, were performed 16 embolizations of the arteries of the parapancreatic zone due to complications of chronic pancreatitis. Among the patients there were 13 (81.25%) men and 3 (18.75%) women. They had a history of chronic pancreatitis, which was confirmed using instrumental and laboratory research methods. One of the patients (6.25%) had a stationary aneurysm.15 (93.75%) patients had a bleeding clinic, which required urgent surgical interventions. Results. Angioembolization of the parapancreatic arteries was effective in 15 (93.75%) patients, which was confirmed by the results of control angiograms. Conclusions. The use of intraluminal embolization for vascular pathology of the parapancreatic zone in treatment of chronic pancreatitis complications is a minimally invasive and effective method.

Comparative Analysis of the Results of Various Methods for Pancreatic Head Resection in Chronic Pancreatitis

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.

Immediate and Long-Term Results of Original Methods of Longitudinal Pancreatojejunostomy With The Expansion of the Area of Pancreatojejunal Anastomosis

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.

Surgical treatment for chronic pancreatitis: A single-center retrospective study in Japan.

To determine the short- and long-term results of surgical treatments for chronic pancreatitis (CP) at a high-volume center in Japan. The records of 151 consecutive patients undergoing surgery for CP were retrospectively reviewed. Selection of surgical procedures used had been according to the Japanese Clinical Practice Guidelines for CP 2015. Long-term (≥1year) follow-up was performed in 100 patients (median of 37months). Surgical drainage procedures were performed in 107 patients (Frey operation in 81, longitudinal pancreaticojejunostomy in 26), pancreatic resection in 37 (subtotal stomach-preserving pancreaticoduodenectomy in 11, distal pancreatectomy in 26), and other procedures in six. The rates of postoperative mortality and morbidity were 1% and 26%, respectively. The rates of complete and partial pain relief were 62% and 37%. The frequency of occurrence of severe morbidity was significantly higher after pancreatic resection than in patients receiving drainage procedures (13% vs 2%, P=.019). The rate of new-onset diabetes was also significantly higher after resection than drainage (60% vs 25%, P=.017). Surgical treatment for painful chronic pancreatitis can be safe and effective. An optimal procedure should guarantee pain relief and preserve a maximum of pancreatic function.

Comparison of single-layer continues or two-layer interrupted pancreatojejunal suture in Frey procedure for treatment of chronic pancreatitis: a prospective randomized study.

Many patients with chronic pancreatitis are elected for surgery when endoscopic interventions are ineffective. Duodenum preserving pancreatic head resection introduced by Charles F. Frey is the most common procedure used for surgical treatment of chronic pancreatitis. However, technical aspects of this procedure have not been studied extensively. Goal Our prospective randomized study is aimed to compare usage of single-layer continuous (I group) and two-layer interrupted sutures (II group) in constructing pancreatojejunostomy after Frey procedure. In a period between 2009 and 2016, a total of 103 patients, diagnosed with chronic pancreatitis and determined medical indications for surgical treatment were included into the study and randomized into group I (52 patients) and group II (51 patients). Preoperative, intraoperative patient characteristics and postoperative results were compared between both groups. Mean duration of surgery was statistically shorter in group I - 210 min, while in group II - 240 min (p = 0.004). Pancreatojejunoanastomosis construction time was shorter in group I - 19 (±6) min versus 51 (±18) min in group II, p <0,001. No statistically relevant differences were observed in postoperative morbidity: group I - 51.9% and group II - 45,1% (p = 0.177) and mortality: group I - 3.8% and group II - 2% (p = 0.636). Frey procedure using single-layer continuous pancreatojejunostomy is safe, fast and less complex method in surgical treatment of chronic pancreatitis.