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.

Summary. Purpose. To optimize the tactics of endoscopic interventions for cholelithiasis complicated by obstruction of the terminal portion of the common bile duct to reduce the incidence of postoperative complications and mortality in elderly and senile people. Materials and methods. The results of examination and treatment of 221 elderly and senile patients with cholelithiasis complicated by obstruction of the terminal section of the common bile duct were analyzed. Results. Using of existing methods and proposed new methods of endoscopic management of cholelithiasis complicated by obstruction of the terminal section of the common bile duct allow to reliably reduce the incidence of postoperative complications in elderly and senile patients from 19.8 to 9.5%, postoperative mortality from 10.3 to 2.9% Conclusions. In elderly and senile patients with obstruction of the terminal section of the common bile duct and common bile duct stones who bear high operational risk, endoscopic papillosphincterotomy with stone removal is a sufficient method of treatment. In case of unremovable common bile duct stones, endoscopic papillosphincterotomy and stenting allow to avoid revision of the common bile duct, and in high-risk patients those methods allow to refrain from open surgery.

Background. The majority of studies on the surgical treatment of chronic pancreatitis (CP) compare treatment outcomes by the type of the procedure. However, some studies, especially systematic reviews and meta-analyses, indicate the equality of different surgeries by their long-term results. During last 5–9 years, several studies showed advantages of early surgery in chronic pancreatitis, within three years after symptoms onset. Objective: to analyze the short- and long-term results of surgical treatment for chronic pancreatitis regarding timing and, accordingly, the neglect of the disease. Materials and methods. Retrospective analysis of data of 147 patients from 2001 to 2020, the main intervention was surgery aimed at the main manifestations of CP, such as pancreatic ductal and/or parenchymal hypertension. Patients who suffered from CP symptoms 3 years or more were included in the control group (late surgery), and those who noted symptoms of CP for less than 3 years were included in the study group (early surgery). All patients completed the EORTC QLQ-30, SF-36 questionnaires, as well as the questionnaire developed by the study authors, via telephone or mail, or during the visit. Results. According to all scales of the SF-36 questionnaire, except for Physical functioning, the group of early surgery prevails over the group of late surgery. The early surgery group had the best average scores on all functional scales of the EORTC QLQ-30 questionnaire compared to the late surgery group, except for the Cognitive functioning. Of the symptomatic scales, the early surgery group had the best averages on Pain and Diarrhea. The average Health/Quality of life scale was significantly better in the early surgery group. Conclusions. The quality of life, pain control, pancreatic function in patients operated within 3 years from the onset of CP symptoms were better compared to those with longer disease duration, with the same short-term results. The duration of the disease is a major factor for the success of surgical treatment of chronic pancreatitis in terms of long-term results. The early surgery is effective approach to obtain better long-term outcomes in chronic pancreatitis.