A duodenum-preserving and bile duct–preserving total pancreatic head resection with associated pancreatic duct-to-duct anastomosis

Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.

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Case 4.27

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0125 ◽

2014 ◽

pp. 238-239

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Pancreatic Duct ◽

Bile Ducts ◽

Pancreatic Head ◽

Pancreatic Mass ◽

The Common

67-year-old man with dilated bile ducts and a pancreatic mass on US VR image from 3D FRFSE MRCP (Figure 4.27.1) reveals obstruction of the common bile duct and the pancreatic duct at the level of the pancreatic head. Coronal fat-suppressed 2D SSFP images (...

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Intraoperative bile duct cultures in patients undergoing pancreatic head resection: Prospective comparison of Bile Duct Swab vs. Bile Duct Aspiration

HPB ◽

10.1016/j.hpb.2020.04.650 ◽

2020 ◽

Vol 22 ◽

pp. S135

Author(s):

J. Yonkus ◽

A. Abdelrahman ◽

M. Truty

Keyword(s):

Bile Duct ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Prospective Comparison

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Case 17.20

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0438 ◽

2014 ◽

pp. 827-828

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Pancreatic Duct ◽

Pancreatic Head ◽

Filling Defect ◽

Left Lobe ◽

Distal Common Bile Duct ◽

Hepatic Lobe ◽

The Common

72-year-old man with cholangiocarcinoma in the distal common bile duct VR image from 3D FRFSE MRCP (Figure 17.20.1) demonstrates moderately dilated intrahepatic ducts in the central right hepatic lobe, poorly visualized ducts in the medial left lobe, and dilated ducts in the lateral left lobe. There is an abrupt cutoff of the common bile duct near the pancreatic head, with a stent extending into the duodenum, and an apparent filling defect proximal to the obstruction. Notice also the dilated pancreatic duct. Axial fat-suppressed 3D SSFP images (...

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