Resection and Drainage Operations in Treatment of Chronic Pancreatitis and its Complications

V.G. Yareshko, Yu.A. Mikheyev

Abstract


Introduction. Complications of chronic pancreatitis are usually an indications for surgical treatment. Surgeries for chronic pancreatitis fall into drainage and resection.
The objective of the work was the justification for the choice of resection or drainage operations on the pancreas, depending on the morphostructural changes in the various departments of its parenchyma, the state of the duct system and complications of chronic pancreatitis.
Material and Methods. In the clinic, drainage and resection operations were performed in 83 patients. The most frequently against the fibro-degenerative changes of the pancreas (93.9 %) there were detected had pancreatic ductal hypertension (90.3 %) of various degrees of severity, which in 72.3 % of patients was associated with the main pancreatic duct stones, in 55.4 % of patients — with calcifications of pancreatic parenchyma. Pseudo- and postnecrotic cysts were observed in 45.8 % of patients, the presence of biliary hypertension — in 25.3 %, portal hypertension — in 30.1 %. 8 patients had duodenal obstruction.
Results. We had carried out 3 gastropancreatoduodenectomy resection, 27 distal resectiob of pancreas, 18 longitudinal pancreaticojejunostomy, 29 Frey’s procedures, 5 Beger’s operations, 1 Beger’s operation in Berne modification, 3 patients pancreaticojejunoanastomosis was supplemented with transduodenal papillotomy.
Conclusions. 1. Choosing drainage or resection surgery for chronic pancreatitis from the arsenal of known interventions requires a sufficiently clear definition of indications for each patient based on modern methods of imaging diagnosis of pancreatic pathology with expert-class apparatus and specialists of high professional level. 2. Our proposed modification of resection and drainage operations focus on the main pathomorphological changes in the pancreas and can be added to an arsenal of well-known surgical procedures, especially in difficult situations of the choice of adequate surgery for chronic pancreatitis.


Keywords


chronic pancreatitis; longitudinal pancreaticojejunostomy; Beger’s operation; Frey’s procedure

References


Паренхимосохраняющая направленность в хирургии хронического панкреатита / А.В. Клименко, В.Н. Клименко, С.Н. Завгородний [и др.] // Український журнал хірургії. — 2011. — № 6 (15). — С. 14-18.

Принципы прямых операций на поджелудочной железе в хирургическом лечении хронического панкреатита / В.М. Копчак, И.В. Хомяк, Д.А. Чевердюк [и др.] // Вестник хирургии им. И.И. Грекова. — 2011. — Т. 171, № 3. — С. 29-34.

Резекция головки поджелудочной железы при хроническом панкреатите. Как делать и как называть? (аналитический обзор) / В.И. Егоров, В.А. Вишневский, А.Т. Щастный [и др.] // Хирургия. Журнал им. Н.И. Пирогова. — 2005. — № 8. — С. 57-66.

Щастный А.Т. Хирургическое лечение хронического панкреатита с преимущественным поражением головки поджелудочной железы / А.Т. Щастный, М.И. Кугаев // Новости хирургии. — 2010. — Т. 18, № 2. — С. 27-35.

Beger H.G. Diseases of the Pancreas / Beger H.G., Matsuno S., Cameron J.L. — Berlin: Springer-Verlag, 2008. — 905 p.

Chronic Pancreatitis. Novel Concepts in Biology and Therapy / M.W. Büchler, H. Friess, W. Uhl. P. Malfertheiner. — Blackwell Publishing, 2006. — 734 p.

Ho H.S. The Frey procedure: local resection of pancreatic head combined with lateral pancreaticojejunostomy /

Ho H.S., Frey C.F. // Arch. Surg. — 2001. —

Vol. 136. — P. 1353-1361.

Keith R.G., Keshavjee S.H., Kerenyi N.R. Neuropathology of chronic pancreatitis in humans / Keith R.G., Keshavjee S.H., Kerenyi N.R. // Can. J. Surg. — 1985. — Vol. 28. — P. 207-211.

Mann O. Customized surgical strategy in chronic pancreatitis / Mann O., Izbicki J. R. // Scandinavian Journal of Surgery. — 2005. — Vol. 94. — P. 154-160.

Sawyer R. Is there still a role for distal pancreatectomy in surgery for chronic pancreatitis? / Sawyer R., Frey C.F. // Am. J. Surg. — 1994. — Vol. 168. — P. 6-12.Паренхимосохраняющая направленность в хирургии хронического панкреатита / А.В. Клименко, В.Н. Клименко, С.Н. Завгородний [и др.] // Український журнал хірургії. — 2011. — № 6 (15). — С. 14-18.

Принципы прямых операций на поджелудочной железе в хирургическом лечении хронического панкреатита / В.М. Копчак, И.В. Хомяк, Д.А. Чевердюк [и др.] // Вестник хирургии им. И.И. Грекова. — 2011. — Т. 171, № 3. — С. 29-34.

Резекция головки поджелудочной железы при хроническом панкреатите. Как делать и как называть? (аналитический обзор) / В.И. Егоров, В.А. Вишневский, А.Т. Щастный [и др.] // Хирургия. Журнал им. Н.И. Пирогова. — 2005. — № 8. — С. 57-66.

Щастный А.Т. Хирургическое лечение хронического панкреатита с преимущественным поражением головки поджелудочной железы / А.Т. Щастный, М.И. Кугаев // Новости хирургии. — 2010. — Т. 18, № 2. — С. 27-35.

Beger H.G. Diseases of the Pancreas / Beger H.G., Matsuno S., Cameron J.L. — Berlin: Springer-Verlag, 2008. — 905 p.

Chronic Pancreatitis. Novel Concepts in Biology and Therapy / M.W. Büchler, H. Friess, W. Uhl. P. Malfertheiner. — Blackwell Publishing, 2006. — 734 p.

Ho H.S. The Frey procedure: local resection of pancreatic head combined with lateral pancreaticojejunostomy /

Ho H.S., Frey C.F. // Arch. Surg. — 2001. —

Vol. 136. — P. 1353-1361.

Keith R.G., Keshavjee S.H., Kerenyi N.R. Neuropathology of chronic pancreatitis in humans / Keith R.G., Keshavjee S.H., Kerenyi N.R. // Can. J. Surg. — 1985. — Vol. 28. — P. 207-211.

Mann O. Customized surgical strategy in chronic pancreatitis / Mann O., Izbicki J. R. // Scandinavian Journal of Surgery. — 2005. — Vol. 94. — P. 154-160.

Sawyer R. Is there still a role for distal pancreatectomy in surgery for chronic pancreatitis? / Sawyer R., Frey C.F. // Am. J. Surg. — 1994. — Vol. 168. — P. 6-12.




DOI: https://doi.org/10.22141/1997-2938.3.22.2013.87426

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