Surgery for biliary stricture in chronic pancreatitis
DOI:
https://doi.org/10.11603/2414-4533.2021.4.12479Keywords:
chronic pancreatitis, steatorrhea, biliary stricture, biliary hypertension, mechanical jaundiceAbstract
The aim of the work: to determine the optimal timing of surgery to prevent biliary stricture (BS) in chronic pancreatitis (CP), the optimal type of intervention in the bile ducts, the optimal combination of surgery on the bile ducts and pancreas and to establish indications for the latter.
Materials and Methods. Retrospective analysis of case histories of patients who were operated due to chronic pancreatitis from 2001 to 2020. Diagnostic criteria of BS were mechanical jaundice and/or dilatation of of the hepatic choledochus ≥10 mm. BS was confirmed by intraoperative cholangiography. Choledochoduodenostomy, hepatic and choledochoenterostomy, transduodenal papillosphincterotomy, duodenum-preserving resections of the pancreatic head were performed. The effectiveness of operations assessed by the absence of cholangitis/mechanical jaundice during observation. Statistical analysis was performed using IBM SPSS Version27. Pearsonʼs χ², Fisherʼs exact criterion was used to analyze categorical data. The level of statistical significance is set at p<0.05.
Results and Discussion. No recurrence of BS achieved in 85.7 % of patients. Recurrence of BS (cholangitis/jaundice) was observed in 8 patients (14.3 %). Signs of recurrence were found: in the group of transduodenal papillosphincterotomy in 33.3 %, in 16.7 % of patients with сholedochoduodenostomy, in 9.7 % of patients with duodenum-preserving resections of the pancreatic head . For the latter, resection decompression was supplemented in these patients by fenestration of the choledochus into the resection cavity. BS was observed in 18.8 % of patients with symptoms lasting up to 3 years and in 33.8 % – more than 3 years.
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