SURGICAL TREATMENT OF CHRONIC PANCREATITIS, COMPLICATED BY BILE DUCT AND DUODENAL OBSTRUCTION

Abstract

Objective - the comparative evaluation results of two different treatment strategies for chronic pancreatitis, complicated by bile duct and duodenal obstruc- tion.Material and Methods: The patients were divided into two groups. In the main group we used the following surgical strategy. If possible the preferred operation was pancreaticoduodenectomy. In cases unresectable pancreatic inflammatory head masses, biliary and duodenum drainage procedures were performed. In the main group 19 patients received pancreaticoduodenectomy, 5 - duodenum preserving resection and 30 drainage procedures, in the com- parative group 4 - pancreaticoduodenectomy and 29 drainage procedures (p=0,002).Results: Postoperative morbidity was higher in the main group - 20 (37%) vs 4 (12%), p=0,003. One patient died in the main group after drainage opera- tion. In follow-up in 12 patients (6 per group) were observed false negative results of biopsy and diagnosis of chronic pancreatitis had changed to pancreatic cancer. There were 4 cases of missed curable carcinoma in the comparative group and none in the group with preferred resectional surgery strategy. The quality of life was also better in the main group.Conclusion: The proposed surgical strategy takes into account the probability of false-negative diagnostic results, prevents cases of missed operable pancre- atic cancer in a remote period and gives a better quality of life.