The key role of pancreatic fibrosis severity in the surgical treatment algorithm of patients with chronic pancreatitis

Abstract

The aim of the work was to improve the results of surgical treatment of complicated forms of chronic pancreatitis. Materials and methods: The results of surgical treatment of 181 patients with complicated forms of chronic pancreatitis have been analyzed. All these patients were treated in surgical clinic of 2 nd medical faculty of National Pyrogov Memorial Medical University in Vinnytsya. Results: It is possible preoperative indirectly assess the severity of fibro- degenerative changes in pancreas, that includes 1 – the definition of pain type; 2 – CT or MRI (Marseilles- Rome classification); 3 – assessment of the stage of chronic pancreatitis (Büchler classification); 4 – patient's nutrition status and preoperative differential diagnosis with pancreatic cancer; 5 – assessment of the fibrosis severity (elastomers). The key point in treatment depended on intraoperative examination: detection of strictures of the main pancreatic duct (pacemaker of chronic pancreatitis); the tissue pressure resistance to the liquid, which is the maximum value> 200 mmHg, in the region of stricture and falls in other parts of the pancreas; pressure in the main pancreas duct, which rises only in 59.5% of patients. The head of the pancreas was involved in the pathological process in 83.8%, in 16.2% it was isolated in the isthmus or the body and tail of the pancreas. In general, the distal pancreas was involved in 37.8%. At computer morphometry of histological samples, the area of connective tissue fields reached 81.4 ± 6.62%, preserved exocrine part in 4.87 ± 1.62%, endocrine – 1.92 ± 0.12%, total area of ducts – 6 , 47 ± 1.12%. Conclusions: The combined Frey-Izbickiy local resection provides a wide excision of the pacemaker (stricture) of chronic pancreatitis. In case of extrapancreatic complications or repeated surgical interventions on the pancreas due to chronic pancreatitis, this effect can be achieved by pancreatoduodenal resection.