Surgical treatment in patients with chronic pancreatitis in a multidisciplinary hospital

Abstract

A rational personalized program of surgical treatment of patients with various clinical and morphological forms of chronic pancreatitis is substantiated, integrating modern diagnostic and minimally invasive technologies. Examination results and treatment of 354 patients with chronic pancreatitis were analyzed. Patients were divided into three groups according to the modified Marseille-Rome Classification of Chronic pancreatitis (1988). Calcifying chronic pancreatitis was detected in 119 patients, obstructive in 81, and inflammatory in 154. Modern methods of diagnosis and treatment of chronic pancreatitis allowed the modification of the classification by allocating subgroups for each disease form. The justified use of the entire range of modern surgical technologies, taking into account the morphological changes of the pancreas, allows the maximum correction of complications of chronic pancreatitis with minimal complications and good quality of life in the long-term. The choice of surgical aid in patients with chronic pancreatitis is established to primarily depend on the form and variant of the disease course. The main criteria for choosing a surgical aid should be the state of the pancreatic ductal system, the degree and nature of changes in its parenchyma, and the presence of a cystic or inflammatory component during the surgical decision making. Important adjustments in the stage of surgical interventions are made due to mechanical jaundice, portal hypertension, decompensated duodenal stenosis, and concomitant somatic pathology in patients. Subgroups of patients with identified main chronic pancreatitis form, according to its modified classification, allows the determination of the surgical intervention volume, type, and access for each specific patient.