Wirsungectomy for pancreatic hypertension in chronic pancreatitis

Background. Pain in chronic pancreatitis (CP) can occur as a consequence of mechanical factors — pancreatic ductal hypertension, interstitial pressure, inflammatory and neuropathic pathological changes in the pancreas. The purpose was to evaluate a novel modification of the classic Partington-Rochelle procedure via comparing functional results of conventional surgery group and wirsungectomy group. Materials and methods. A retrospective analysis of the case histories of patients with CP and an enlarged (≥ 4 mm) main pancreatic duct was carried out for the period from 2003 to 2009, which underwent surgical treatment of CP. The SF-36 and EORTC QLQ-C30 questionnaires, and visual analogue scale of pain were used for the assessment. The first group included five patients with wirsungectomy with lateral pancreaticojejunostomy (PEA + WE); the second group consisted of 20 patients after the lateral pancreaticojejunostomy (PEA) only. Cross-tabulation analyses were performed to compare PEA and PEA + WE groups as well as those groups in different time points using a two-sided Student’s t-test. The significance level was set to p < 0.05. Results. The groups were compared in terms of VAS and the EORTC QLQ-C30 questionnaire before and 2 years after surgery using Student’s t-test for unrelated values: statistically significant differences between the groups according to VAS as before (p = 0.757) and after surgery (p = 0.696) were not obtained. There were no significant differen­ces (p > 0.05) between the PEA and PEA + WE groups before and after surgery according to the EORTC QLQ-C30 questionnaires, except for some items (p < 0.05) Within the groups according to VAS and EORTC QLQ-C30 (pain severity), in the PEA group (p = 0.000001, p = 0.000109) and the PEA + WE group (p = 0.018, p = 0.017) after surgery, there was a statistically significant decrease in pain. Conclusions. Longitudinal pancreaticojejunostomy with wirsungectomy is justified in patients with long-term CP, severe fibrosis of the pancreas with multiple calcifications of the periphery pancreatic ducts to decompress pancreatic ducts, and parenchyma. In the long-term period after 2 years, the proposed method of longitudinal pancreaticojejunostomy with wirsungectomy in patients with CP with dilation of main pancreatic duct according to the VAS scale and EORTC QLQ questionnaires C30 and SF-36 is accompanied by a significant reduction in pain.

THE LOCAL RESECTION OF THE HEAD OF THE PANCREAS WITH DUODENUM PRESERVING AT THE CHRONIC PANCREATITIS

Aims/Objectives. The purpose of our research was studying of the reasons to increase head of the pancreas with a comparative estimation of morphological changes and outcomes of surgical treatment at patients by whom the local resection of the head of the pancreas with duodenum- preserving has been executed. Materials and methods. Results of the surgical treatment and morphological changes of 104 patients were studied: a local resection of the head of the pancreas with longitudinal pancreaticojejunostomy (LRHP+LPJ, n = 33), LRHP without LPJ (LRHP—LPJ' n = 36) and a local resection of the head and isthmus of the pancreas without LPJ (LRHIP—LPJ, n = 35). Results and discussion. In comparison groups has been revealed statistically significant distinction (Н = 17,357, df = 2, р = 0,002) on the sizes of the pancreas head. In their groups has been revealed statistically significant distinction in the sizes intrapancreatic pseudocysts in the pancreas head (Н = 8,912, df = 2, р = 0,012). The Spearman correlation (Spearman, p) had been found out statistically significant strong direct dependence between variables «the sizes of the pancreas head» and «the sizes intrapancreatic pseudocysts in the pancreas head «in comparison groups: LRHP+LPJ p = +0,73, р < 0,0001, LRHP-LPJ p = +0,78, р < 0,0001, LRHIP-LPJ p = +0,76, р < 0,0001. Between three groups of the patients by quantity of complications after operation were statistically significant (x2 = 10,644, df = 2, р = 0,005). In comparison groups has not been established distinctions on presence of the complications with focal or diffuse perilobular fibrosis — С < 0,200 or intralobular fibrosis — С < 0,265, and presence periductal fibrosis — С = 0,124. Conclusions. The sizes of the pancreas' head in the compared groups directly depend on the sizes intrapancreatic pseudocysts in the pancreas head. The probability of the complications' development after operation is not depended with focal or diffuse perilobular fibrosis or intralobular fibrosis and presence periductal fibrosis.

Outcome after Lateral Pancreaticojejunostomy for Chronic Calcific Pancreatitis: A Short Term Prospective Study

Chronic pancreatitis is a fairly common condition with pain being the major symptom and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess the outcome of LPJ for chronic calcific pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational study enrolling 28 patients was conducted in the department of surgery of Shaheed Suhrawardy Medical College Hospital from January 2018 to December 2018. This study involved identification of various risk factors related to chronic pancreatitis, pancreaticojejunostomy, early post-operative outcome and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief of pain in post-LPJ; the degree of relief was less in the alcoholics than non-alcoholics (p=0.09) and in smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. In chronic pancreatitis, there is a significant relief of pain in post-LPJ, although the degree of relief is less in the alcoholics and smokers. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 13-16