Background: Biliary stricture (BS) in chronic pancreatitis (CP) is observed in up to 21% of patients with CP. However, there are no clearly established criteria when the one should operate in case of the CBD dilatation without increased liver enzymes. Attention is now paid to endoscopic interventions, the disadvantage of which is the need for repeated procedures, as well as less effectiveness in the treatment of pain in CP, while the operation can be aimed at various manifestations of CP. Early surgery -up to 3 years from onset of symptoms of CP showed improved results in terms of pain and exocrine function, but it is unknown whether it is of value in prevention of BS. Goal. To determine the optimal timing of surgery to prevent biliary stricture in CP, the optimal type of intervention in the bile ducts, the optimal combination of surgery on the bile ducts and pancreas and to establish indications for the latter. Materials and methods: Retrospective analysis of case histories of patients who were operated due to chronic pancreatitis from 2001 to 2020. Diagnostic criteria of BS were mechanical jaundice and/or dilatation of CBD ≥10 mm. BS was confirmed by intraoperative cholangiography (IOCG). Choledochoduodenostomy (CDS), hepatic and choledochoenterostomy (GEA / HEA), transduodenal papillosphincterotomy (TDPST), duodenum-preserving resections of the pancreatic head (DPRPH) were performed. The effectiveness of operations assessed by the absence of cholangitis / mechanical jaundice during observation. Statistical analysis was performed using IBM SPSS Version27. Pearson's χ², Fisher's exact criterion, was used to analyze categorical data. The level of statistical significance is set at p <0,05 . Results: No recurrence of BS achieved in 85.7% of patients. Recurrence of BS (cholangitis / jaundice) was observed in 8 patients (14.3%). Signs of recurrence were found: in the group of TDPST in 33.3%, in 16.7% of patients with CDS, in 9.7% of patients with DPRPH. For the latter, resection decompression was supplemented in these patients by fenestration of the choledochus into the resection cavity. BS was observed in 18.8% of patients with symptoms lasting up to 3 years and in 33.8% -more than 3 years. Conclusions: Surgery up to 3 years from the onset of symptoms of CP prevents the occurrence of BS. Dilatation of the choledochus ≥10 mm in a patient with CP indicates the presence of BS. In the case of an inflammatory mass or pseudocyst in the head of the pancreas as a cause of BS, it may be sufficient to eliminate it via DPRPH, in particular Frey's procedures. If external decompression of the CBD was not sufficient, the best operation is choledochoenteroanastomosis (GEA / HEA). In the absence of inflammatory mass in the head, it is also advisable to combine pancreatojejunostomy with GEA / HEA.
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