Surgical treatment of chronic pancreatitis with biliary hypertension

  • I. M. Shevchuk Ivano–Frankivsk National Medical University
  • V. I. Pylypchuk Ivano–Frankivsk National Medical University
  • A. D. Khrunik Ivano–Frankivsk National Medical University
  • S. M. Gedzik Ivano–Frankivsk National Medical University
Keywords: chronic fibrous–degenerative pancreatitis, biliary hypertension, surgical treatment, results

Abstract

We analysed the results of treatment of 25 patients suffering from fibrous–degenerative chronic pancreatitis (CP) with biliary hypertension who underwent Frey’s procedure. Control group consisted of 13 (52%) patients who underwent classical Frey’s procedure when Roux–en–Y pancreaticojejunostomy (PJS) was performed. 4 (16%) patients were performed Frey’s procedure with hepaticojejunostomy (HJS). Main group consisted of 8 (32%) patients who underwent modified Frey’s procedure when PJS was performed on isolated jejunal segment, together with duodenojejunostomy with the distal segment of jejunum, cholecystectomy, lateral to lateral HJS and interintestinal Roux–en–Y anastomosis. Original approach was used to evaluate the pressure in the extrahepatic biliary ducts. Long–term results were analyzed in 13 patients. In the control group mean Physical Health Summary score (PHs) was 42.9 ± 0.9, Mental Health Summary score (MHs) – 57.6 ± 1.9, Bodily Pain Scale score (BP) was 60.3 ± 5.2. In the main group PHs was 47.1 ± 1.1, MHs – 61.5 ± 1.5, BP – 68.4 ± 4.2. The suggested modification of fibrous–degenerative CP surgery has advantages, demonstrates promising long–term results and may be used in such patients.

References

1. Yareshko VG, Mikheev YuA. Vybor metoda khirurgicheskogo lecheniya khronicheskogo pankreatita i ego oslozhneniy. ХХIII z’izd khirurhiv Ukrainy. Klinichna khirurhiia, 2015:219–20. [In Russian].

2. di Sebastiano P, di Mola FF. Pathophysiology of Chronic Damage. In: Testoni PA, Mariani A, Arcidiacono PG, editors. Acute and Chronic Pancreatitis: New concepts and evidence–based approaches. Turin: Edizioni Minerva Medica, 2013:63–9.

3. Dobrov SD, Polyakevich AS, Blagitko EM, Tolstykh GN. Zhelchnaya gipertenziya u bol’nykh khronicheskim pankreatitom. Annaly khirurgicheskoy gepatologii. 2012;(4):35–8. [In Russian].

4. Ratchik VM, Gaydar YUA. Khirurgicheskaya korrektsiya oslozhnennykh form khronicheskogo pankreatita. Suchasna khіrurgіya ta koloproktologіya. 2012;4 (4):53–7. [In Russian].

5. Büchler MW, Baer HU, Seiler C. Duodenum preserving resection of the head of the pancreas: a standard procedure in chronic pancreatitis. Chirurgie. 1997 Aprl;68(4):364–8.

6. Kopchak VM, Usenko AYu, Kopchak KV, Zelinskiy AI. Khirurgicheskaya anatomiya podzheludochnoy zhelezy. Kiev: Izdatelskiy dom «Askaniya», 2011. 141 s. [In Russian].

7. Strate T, Taherpour Z, Bloechle C, Mann О, Bruhn JP, Schneider С, et al. Long–term follow–up of a randomized trial comparing the Beger and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg. 2005;241:591–8.

8. Vorobey AV, Shuleyko ACh, Orlovskiy YuN, Vizhinis YuI, Lagodich NA. Biliarnaya gipertenziya pri khronicheskom pankreatite. Novosti khirurgii. 2014;(4):408–15. [In Russian].

9. Galperin EI, Dyuzheva TG, Akhaladze GG. KHronicheskiy pankreatit, rezetsiruyushchie i dreniruyushchie vmeshatelstva. Khirurgiya. Zhurnal im. NI Pirogova. 2006;(8):4–9 [In Russian]..

10. Rezolyutsiya Plenuma Pravleniya Assotsiatsii khirurgov–gepatologov Rossii i stran SNG (Izhevsk 19 – 20 apr 2012 g.) «Khronicheskiy pankreatit». Annaly khirurgicheskoy hepatologii. 2012;17(3):118–9. [In Russian].

11. Sposib khirurhichnoho likuvannia khronichnoho pankreatytu, uskladnenoho obturatsiinoiu zhovtianytseiu: pat. 93960 Ukraina. № u201404410; zaiavl. 24.04.2014; opubl. 27.10.2014, Biul. № 20. [ [In Ukrainian].

12. Sposib khirurhichnoho likuvannia khronichnoho pankreatytu: pat. 45721 A Ukraina. № 2001064111; zaiavl. 14.08.2001; opubl. 15.04.2002, Biul. № 4 [ [In Ukrainian].

13. Sposib formuvannia pankreatoieiunoanastomozu: pat. 83028 Ukraina. № u201302157; zaiavl. 21.02.2013; opubl. 27.08.2013, Biul. № 16. [ [In Ukrainian]

14. Sposib vymiriuvannia tysku v zahalnii zhovchovyvidnii prototsi: pat. 109547 Ukraina. № u201602279; zaiavl. 10.03.2016; opubl. 25.08.2016, Biul. № 16. [ [In Ukrainian]

15. Sposib khirurhichnoho likuvannia khronichnoho pankreatytu, uskladnenoho zhovchnokam’ianoiu khvoroboiu: pat. 101713 Ukraina. № u201503315; zaiavl. 09.04.2015; opubl. 25.09.2015, Biul № 18.

16. Shevchuk ІМ, Pylypchuk VІ, Gedzyk SМ. Еndoscopic transpapillary interventions in chronic pancreatitis. Klinichna khirurhiia. 2014;(3):19–22. [ [In Ukrainian]
Published
2017-09-07
How to Cite
Shevchuk, I. M., Pylypchuk, V. I., Khrunik, A. D., & Gedzik, S. M. (2017). Surgical treatment of chronic pancreatitis with biliary hypertension. Klinicheskaia Khirurgiia, (8), 27-30. https://doi.org/10.26779/2522-1396.2017.08.27
Section
General Problems of Surgery