Study of Quality of Life in Patients Who Underwent Surgery for Chronic Pancreatitis Complicated by Biliary Hypertension

V. I. Pylypchuk

Abstract


In 2009-2015, 127 patients with complicated forms of chronic pancreatitis (CP) underwent surgical treatment at the department of general surgery of the Ivano-Frankivsk Regional Clinical Hospital. Chronic pancreatitis was accompanied by biliary hypertension in 39 (30.7%) patients. In 14 (11.1%) patients biliary hypertension was combined with chronic duodenal obstruction (CDO) and in 4 (3.1%) patients a combination of BH + CDO and local venous hypertension (VH) of the vessels in pancreatobiliary area was found. There were 36 (92.3%) men and 3 (7.7%) women at the age of 21 to 60 years. Remote results of surgical treatment were assessed when examining patients, performing USG, and filling out the Medical Outcome Study 36-Item Short Form Health Survey (SF-36). All patients with CP complicated by BH underwent surgery. 5 (12.8 %) patients underwent the Whipple resection,  11 (28.3 %) patients underwent the Frey’s procedure, in 2 (5.1 %) patients the Berne modification of Beger procedure was performed, in 8 (20.5 %) patients longitudinal pancreaticojejunostomy was performed, 7 (17.9 %) patients underwent endoscopic intervention of the main pancreatic duct (in 2 patients endoscopic cystoduodenostomy was performed and 5 patients underwent transpapillary intervention of bile ducts and the main pancreatic duct), biliodigestive anastomoses were applied to 2 (5.1 %) patients and cystenterostomy was performed in 3 (7.7 %) patients. Quality of life was traced in 24 (61.5 %) patients during the period from six month to 5 years after surgery. The lowest indicators of quality of life were found among the patients who underwent endoscopic interventions. Surgical resection of the pancreas in CP and BH (the Frey’s procedure, the Berne modification, and pancreaticoduodenal resection) were accompanied by better indicators of quality of life in the remote postoperative period in comparison with drainage operations (including endoscopic ones), which did not eliminate the morphological substrate of the disease and did not prevent the progression of the disease. To obtain good remote results of surgical treatment of patients with CP complicated by BH and improve their quality of life, it is necessary to conduct complete pre-surgery examination of patients, assess the intraoperational situation adequately and select surgical procedure according to individual indicators.


Keywords


chronic pancreatitis; quality of life; biliary hypertension

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