Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2014 Vol. 22 No 4

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.4.408   |  

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 Education1, Minsk,
Republican Center of Reconstructive Surgical Gastroenterology, Coloproctology and Laser Surgery 2,
ME Minsk Regional Clinical Hospital3,
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, patients 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.

Keywords: chronic pancreatitis, biliary hypertension, surgical treatment, double balloon enteroscopy
p. 408 415 of the original issue
References
  1. Schlosser W, Poch B, Beger H. Duodenum preserving pancreatic head resection leads to relief of common bile duct stenosis. Am J Surg. 2002;183:3741.
  2. Kubyshkin VA, Kozlov IA, Kriger A., Chzhao AV. Khirurgicheskoe lechenie khronicheskogo pankreatita [Surgical treatment of chronic pancreatitis]. Ann Khirurg Gepatoli. 2012;17(4):24-34.
  3. Vijungco JD, Prinz RA. Management of biliary and duodenal complications of chronic pancreatitis. World J Surg. 2003 Nov; 27(11):125870.
  4. Riediger H, Adam U, Fischer E, Keck T, Pfeffer F, Hopt UT, Makowiec F. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg. 2007 Aug;11(8):949-59.
  5. Dobrov SD, Poliakevich AS, Blagitko EM, Tolstykh GN. Zhelchnaia gipertenziia u bol'nykh khronicheskim pankreatitom [Biliary hypertension in patients with chronic pancreatitis]. Ann Khirurg Gepatol. 2012;17(4):3641.
  6. Rashhinskij CM, Tret'jak SI, Rashhinskaja NT. Ocenka rezul'tatov hirurgicheskogo lechenija biliarnyh oslozhnenij hronicheskogo pankreatita [Results of surgical treatment of biliary complications of chronic pancreatitis]. Medicin Zhurn. 2013;(3):9598.
  7. Warshaw AL, Rattner DW. Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts. Ann Surg. 1980 Jul;192(1):33-7.
  8. Sugerman HJ, Barnhart GR, Newsome HH. Selective drainage for pancreatic, biliary, and duodenal obstruction secondary to chronic fibrosing pancreatitis. Ann Surg. 1986; 203(5):55867.
  9. Littenberg G, Afroudakis A, Kaplowitz N.Common bile duct stenosis from chronic pancreatitis: a clinical and pathologic spectrum. Medicine (Baltimore). 1979 Nov;58(6):385412.
  10. Frey CF, Suzuki M, Isaji S. Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg. 1990 Jan-Feb;14(1):5969.
  11. Catalano MF, Linder JD, George S, Alcocer E, Geenen JE.Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents. Gastrointest Endosc. 2004 Dec;60(6):94552.
  12. Cahen DL, Rauws EA, Gouma DJ, Fockens P, Bruno MJ.Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy. 2008 Aug;40(8):697700.
  13. Deviere JM, Reddy DN, Puspok A, Ponchon T, Bruno MJ, Bourke MJ, Neuhaus H, Roy A, Gonzalez-Huix F, Barkun AN, et al. 147 Preliminary Results From a 187 Patient Multicenter Prospective Trial Using Metal Stents for Treatment of Benign Biliary Strictures. Gastrointest Endosc. 2012;75:AB123.
  14. Traverso LW, Kozarek RA.Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Ann Surg. 1997 Oct;226(4):42935.
  15. Buchler MW, Warshaw AL.Resection versus drainage in treatment of chronic pancreatitis. Gastroenterology. 2008 May;134(5):16057.
  16. Vorobej AV, Grishin IN, Shulejko ACh, Lur'e VN, Orlovskij JuN, Vizhinys JuI, Butra JuV, Lagodin NA. Patogeneticheskoe obosnovanie pervichnyh i povtornyh operacij na podzheludochnoj zheleze pri hronicheskom pankreatite [Pathogenetic substantiation of primary and repeat operations on the pancreas in chronic pancreatitis]. Ann Hirurg Gepatol. 2012;17(3):8088
Address for correspondence:
220013, Respublika Belarus, g. Minsk, ul. P. Brovki d.3, k.3, GUO Belorusskaya akademiya poslediplomnogo obrazovaniya, kafedra khirurgii,
e-mail: varabeiproct@tut.by,
Vorobey Aleksandr Vladimirovich
Information about the authors:
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.
Contacts | ©Vitebsk State Medical University, 2007