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Year 2014 Vol. 22 No 4
GENERAL AND SPECIAL SURGERY
A.V. VARABEI 1,2, A.CH. SHULEIKA 1,2, Y.N. ARLOUSKI 1,2, Y.I. VIZHINIS 1,2, N.A. LAGODICH 2,3
BILIARY HYPERTENSION IN CHRONIC PANCREATITIS
SEE “Belarusian Medical Academy of Post-Graduate Education”1, Minsk,
Republican Center of Reconstructive Surgical Gastroenterology, Coloproctology and Laser Surgery 2,
ME “Minsk Regional Clinical Hospital”3,
The Republic of Belarus
Objectives. To carry out an analysis of the surgical treatment results and validate the choice of operation in patients with chronic pancreatitis complicated by biliary hypertension and evaluate the role of double balloon enteroscopy in diagnostics and treatment of postoperative complications after pancreatic surgeries.
Methods. The results of surgical treatment of 187 patients with chronic pancreatitis have been analyzed. Biliary hypertension occurred in 67 (35,8%) cases, different types of surgical correction have been performed. In the postoperative period 14 examinations of the pancreatico-jejuno anastomosis state by means of the double balloon enteroscopy have been performed.
Results. Biliary postoperative complications were registered in 5,9% cases, including strictures of biliodigestive anastomosis – 1,5% cases, leakage of the anastomosis – in 4,4%. Berne variant of Beger's operation was performed with intrapancreatic choledocholysis and biliary anastomosis creation in 50 (74,6%) cases, complications occurred in 2%. Extrapancreatic bypass surgery was performed in 17,1% cases, complications occurred in 15,3%. Double balloon enteroscopy during the examination of pancreato-jejunoanastomosis zone succeeded in 90% of cases, the later biliary complications were identified with their correction performance: laser recanalization of strictures and laser lithotripsy of residual concrements.
Conclusions. The choice of surgical correction of biliary hypertension should be individualized depending on the presence of jaundice, other complications of chronic pancreatitis, patient’s somatic state. The suggested surgical tactics on the basis of the biliary hypertension classification lets to optimize surgical approaches. Optimal surgical approach in patients with chronic pancreatitis and biliary hypertension is considered to be Berne variant of Beger's operation with intrapancreatic biliary anastomosis permitted to correct immediately all complications of chronic pancreatitis. Extrapancreatic shunt operation is considered to be recommended for performance in the absence of complications and inability to allocate intrapancreatic part of choledoch. The double balloon enteroscopy is preferable to use for diagnostics and treatment in the cases of late complications after biliodigestive anastomoses.
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220013, Respublika Belarus, g. Minsk, ul. P. Brovki d.3, k.3, GUO «Belorusskaya akademiya poslediplomnogo obrazovaniya», kafedra khirurgii,
Vorobey Aleksandr Vladimirovich
Varabei A.V. MD, professor, a head of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Shuleika A.Ch. PhD, an associate professor of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Arlouski Y.N. PhD, an assistant of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Vizhinis Y.I. An assistant of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate Education”.
Lagodich N.A. An endoscopist of the endoscopic department of ME “Minsk Regional Clinical Hospital”.