Surgical Procedures for Biliary Stricture in Chronic Pancreatitis

Abstract

Background: Biliary stricture (BS) in chronic pancreatitis (CP) is observed in up to 21% of patients with CP. However, there are no clearly established criteria when the one should operate in case of the CBD dilatation without increased liver enzymes. Attention is now paid to endoscopic interventions, the disadvantage of which is the need for repeated procedures, as well as less effectiveness in the treatment of pain in CP, while the operation can be aimed at various manifestations of CP. Early surgery - up to 3 years from onset of symptoms of CP showed improved results in terms of pain and exocrine function, but it is unknown whether it is of value in prevention of BS. Goal. To determine the optimal timing of surgery to prevent biliary stricture in CP, the optimal type of intervention in the bile ducts, the optimal combination of surgery on the bile ducts and pancreas and to establish indications for the latter. Materials and methods: Retrospective analysis of case histories of patients who were operated due to chronic pancreatitis from 2001 to 2020. Diagnostic criteria of BS were mechanical jaundice and/or dilatation of CBD ≥10 mm. BS was confirmed by intraoperative cholangiography (IOCG). Choledochoduodenostomy (CDS), hepatic and choledochoenterostomy (GEA / HEA), transduodenal papillosphincterotomy (TDPST), duodenum-preserving resections of the pancreatic head (DPRPH) were performed. The effectiveness of operations assessed by the absence of cholangitis / mechanical jaundice during observation. Statistical analysis was performed using IBM SPSS Version27. Pearson's χ², Fisher's exact criterion, was used to analyze categorical data. The level of statistical significance is set at p <0,05 .