SURGICAL TACTICS FOR CHRONIC CALCULOUS PANCREATITIS

Aim. To determine surgical tactics and principles of preferential surgical intervention for chronic calculous pancreatitis based on assessment of results of various approaches and methods of surgical correction.

Material and Methods. Since January 1989 till March 2016 475 patients were treated. There were 234 draining, 15 resection-draining operations and 14 resections. In 174 patients (36.6%) 2 or more operations were executed due to ineffective primary intervention.

Results. Two patients died after draining operations. After draining operations the incidence of early and long-term postoperative complications was 10.3% and 23.9% respectively, after resection-draining operations – 6.7% and 13.3%; after resections – 21.4% and 78.6%. Obstructive jaundice was not observed after resection-draining operations. One patient had pancreatic diabetes and recurrent abdominal pain. Topographic and anatomical features of calculous pancreatic changes were established. Ductal hypertension is accompanied by its enlargement in 75.9% of patients. Pancreatic stones are predominantly localized in glandular head along anterior surface. Virsungolithiasis was noted in 20–25% of patients.

Conclusion. Parenchyma-sparing interventions are more effective compared with resections. In our opinion, the most advisable surgery for chronic calculous pancreatitis are resection-draining operations including longitudinal pancreaticocystojejunostomy by Frey’s procedure type supplemented by contact ultrasound lithotripsy. It is suggested clinical classification of chronic calculous pancreatitis that should be kept in mind to determine surgical tactics. 

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