Surgical treatment for patients with chronic pancreatitis complicated by biliary hypertension
DOI:
https://doi.org/10.11603/2414-4533.2017.4.8256Keywords:
chronic pancreatitis, biliary hypertension, duodenum-preserved resection of pancreatic gland.Abstract
The aim of the work: to improve the efficiency of treatment of patients with chronic pancreatitis (CP) with signs of biliary hypertension (BH) due to the increased accuracy of pre-operative and intra-operative diagnosis using modern methods of the patient’s examination, reasoning of adequate approaches to surgical treatment.
Materials and Methods. During 2011–2017 170 patients with complicated forms of CP underwent surgical intervention at the Department of General Surgery of Ivano-Frankivsk Regional Clinical Hospital. For diagnosis of BH there were used such methods: laboratory findings (level of general and direct bilirubin, alkaline phosphatase), ultrasound examination (USE), endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT) with contrast enhancement, magnetic resonance cholangiopancreatography (MRCP), method of intraoperative monitoring of biliary pressure (IOM BP).
Results and Discussion. In 60 (35.3 %) patients the CP was accompanied by BH. Prior to surgery, jaundice has occurred only in 47 (78.3 %) patients, and hyperbilirubinemia was – in 49 (81.6 %) patients. During ultrasound examination the distension of suprapancreatic portion of choledochus from 8 mm was diagnosed in 85.0 % of patients, during ERCP – in 90.1 %, during CT – in 85.0 % of patients, and during MRCP – in 100.0 % of patients. In 26 patients the IOM BP method was used. Patients with CP with BH were performed: resection-type surgery – 45 (75.0 %) patients, operations of drainage type – 9 (15.0 %) patients; palliative operations – 6 (10.0 %) patients. The use of IOM BP allowed the detection of the latent BH, performance of its intraoperative correction and assessment of the adequacy of the resection performance and resection-drainage operations on the pancreatic gland (PG) in CP as for the unloading of bile ducts. Standard resection and resection-drainage surgical interventions allowed the elimination of BH only in 61.5 % of patients; in 38.5 % of patients they were supplied with drai nage operations in the bile ducts.
References
Yareshko, V.G. & Mikheev, Yu.A. (2015). Vybor metoda khirurgicheskogo lecheniya khronicheskogo pankreatita i yego oslozhneniy [Choice of the surgical treatment method of chronic pancreatitis and its complications]. XXIII z’í̈zd khírurgív Ukraí̈ni. Zbírnik naukovikh robít – XXIII Congress of Surgeons of Ukraine. Collection of Scientific Works. Kyiv, 219-220 [in Russian].
Gagua, A.K., Vorobyov, P.Yu. & Valkov, K.C. (2016). Vybor optimalnogo ob"yema operatsii u bol'nykh khronicheskim pankreatitom, oslozhnennym biliarnoy gipertenziyey [The choice of the optimal operation volume in patients with chronic pancreatitis complicated by the bile hypertension]. Materialy KHKHIII Mezhdunarodnogo Kongressa Assotsiatsii gepatopankreatobiliarnykh khirurgov stran SNG «Aktualnyye problemy gepatopankreatobiliarnoy khirurgii» – Materials of the XXIII International Congress of the Association of hepatopancreatobiliary surgeons of the CIS countries “Topical problems of hepatopancreatobiliary surgery”. Minsk, 230-231 [in Russian].
Galperin, E.I., Diuzheva, T.G., Semenenko, I.A. (2012). Otdalenyye rezul'taty izolirovannoy rezektsii golovki podzheludochnoy zhelezy s dekompressiyey pankreaticheskikh protokov u bol'nykh khronicheskim pankreatitom [Remote results of isolated resection of the head of the pancreas with decompression of the pancreatic ducts in patients with chronic pancreatitis]. Materialy Plenuma pravleniya Assotsiatsii khirurgov- gepatologov Rossii i stran SNG (19–20 aprelya 2012 goda). – Izhevsk Materials of the Plenum of the Board of the Association of Surgeons – Hepatologists of the Russia and CIS countries (April 19-20, 2012). Izhevsk, 13-15 [in Russian].
Büchler, M.W., Baer, H.U. & Seiler, C. (1997). Duodenum preserving resection of the head of the pancreas: a standard procedure in chronic pancreatitis. Chirurgie, 68, (4), 364-368.
Kleeff, J., Stöß, C. & Mayerle, J. (2016). Evidence-based surgical treatments for chronic pancreatitis. Deutsches Ärzteblatt Internationalt, 113, 489-496.
Grinevich, V.B., Maistrenko, N.A. & Pryadko, A.S. (2012). Problema khronicheskogo pankreatita s pozitsiy terapevta i khirurga [The problem of chronic pancreatitis from the position of the therapist and surgeon]. Meditsinskiy akademicheskiy zhurnal – Medical academic journal, 12(2), 35-55 [in Russian].
Shuleiko, A.Ch., Vorobei, A.V. & Grishin, I.N. (2013). Biliarnaya gipertenziya u bolnykh khronicheskim pankreatitom [Biliary hypertension in patients with chronic pancreatitis]. Materials of the Jubilee International Congress of the Association of Surgical Hepatologists of the CIS countries “Actual problems of surgical hepatology”. Donetsk, 301 [in Russian].
Strate, T., Taherpour, Z. & Bloechle, C. (2005). Long-term follow-up of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis. Annals of Surgery, 241, 591-598.
Patent 101713 Ukraine, IPC A 61B 17/00. Method of surgical treatment of chronic pancreatitis complicated by cholelithiasis. / Pylypchuk VI, Kopchak VM, Shevchuk IM. (Ukraine). - № 2015 03315; stated on 04/09/05; was published 25.09.15 Bull №18.
Patent 109547 Ukraine, IPC A 61B 17/00. Method of measuring pressure in the common bile duct. / Pylypchuk VI, Kopchak VM, Shevchuk IM. (Ukraine). - № u 2016 02279; stated on March 10, 2006; was published August 25, Bull № 16.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
