Resection Surgeries on Pancreatic Head in Surgical Treatment of Complicated Forms of Chronic Pancreatitis

V. I. Pylypchuk

Abstract


106 patients with chronic pancreatitis (CP) underwent surgery at the department of surgery of the Ivano-Frankivsk Regional Clinical Hospital during 2009-2014, including 97 (90.5 %) men and 9 (9.5 %) women. Six of these patients had had previous CP surgeries (2 patients had had longitudinal pancreatico-jejunostomy, 3 – endoscopic interventions in extrahepatic biliary tract, and 1 – endoscopic stenting of Wirsung’s duct). However, due to progressive fibrous degenerative changes in pancreatic tissue they required a repeated surgery. Different complications of CP were found in 39 (36.7 %) patients: biliary hypertension (BH) in 26 (24.5 %) patients, chronic duodenal obstruction (CDO) in 10 (9.4 %) patients, combination of CDO and BH and local venous hypertension of pancreatico-biliary area – 4 (3.8 %) patients. Before the operation, diabetes mellitus had been diagnosed in 11(10.4%) patients.

Proximal resection surgeries on pancreatic head were applied in 27 (25.5%) cases, among them: 4 patients underwent pancreatico-duodenal resection, 23 patients – duodenum preserving procedures (including 2 cases according to Beger in Berne modification, and 21 Frey’s procedures). Berne procedure was conducted in 2 male patients 34 and 44 years old. Frey’s procedure was used in 21 cases: 20 male and 1 female patient. Average age of patients is 44±6.6. Four patients (three men and one woman 45.3±8.4 years old) underwent pancreaticoduodenal resection. Two out of 27 patients died (postoperative mortality comprised 7.4%).

Proximal resection procedures on pancreatic head are pathogenetically reasoned in cases of fibrous-degenerative forms of chronic pancreatitis, and allow to eliminate pain syndrome and malfunction of adjacent organs. A significant number of postoperative complications of pancreatic resection surgeries is connected primarily with the injury of pancreatic tissue, and requires less traumatic surgery techniques following specific indications.


Keywords


chronic pancreatitis; pancreas; Frey’s procedure; Beger’s procedure

Full Text:

PDF

References


Bordin, D. S. Recommendations of the Scientific Society of Gastroenterologist of Russia concerning Diagnostics andTreatment of Chronic Pancreatitis. Eksperi-mentalnaya i klinicheskaia gastroenterologiya. 2011; 7: 122-129.

Gubergrits N. B., Lukashevich G.M. Chronic alcoholic pancreatitis. Moscow. 2010: 54.

Kopchak V. M., Kopchak K. V. , Pererva L. A. , Duvalko A. V. Surgical treatment of chronic pancreatitis. Zdorovia Ukrainy. 27.02.2012: 18-19.

Shalimov A. A., Shalimov S. A. , Nechitaylo M. Ye., Radzikhvskiy A. P. Pancreatic surgery. Simferopol. Tavrida. 1997: 506.

Sebastiano P. di., F. F. di Mola, ed. by Testoni P. A. , Mariani A. , Arcidiacono P. G. Pathophysiology of Chronic Damage. Acute and Chronic Pancreatitis: New concepts and evidence-based approaches.Turin. Edizioni Minerva Medica. 2013: 63-69.

Kovalska I., Dronov O., Berehova T., Shvets Yu. Changes of bile composition in patients with chronic pancreatitis. Pancreatology. 2014; 14(3S): S102.

Vantini I., Amodio A., Gabbrielli A., Cristofori C., Frulloni L., Benini L. Chronic pancreatitis: clinical course, pancreatic insufficiency and metabolic consequences. Acute and Chronic Pancreatitis: New Concepts and Evidence-Based Approaches.Turin: Edizioni Minerva Medica. 2013: 71-82.

Yang C., Bliss L., Freedman S., Sheth S., Chau Ng S., Kent T., Moser A., Tseng J. A single-center analysis of surgical treatment for chronic pacreatitis: relatively rare and unevenly deployed. Pancreatology. 2014; 14(3S): S40.

Rutter K., Ferlitsch A., Sautner T. [et al.] Hospitalization, frequency of interventions, and quality of life after endoscopic, surgical, or conservative treatment in patients with chronic pancreatitis. World J. Surg. 2010; 34 (11): 2642-2647.




Copyright (c) 2017 V. I. Pylypchuk

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


IFNMU Logo

Free counters!