Surgical Treatment of Complicated Chronic Pancreatitis: Nine Years of Experience

Abstract

Aim. To analyze and demonstrate the potential of surgical treatment for patients with chronic pancreatitis and its complications in a department of general surgery, and to develop treatment strategies for patients with pancreatogenic pseudocysts in the subdiaphragmatic space and mediastinum.Materials and methods. This study presents the experience of treating 955 patients with complicated chronic pancreatitis over nine years, including an analysis of the treatment of 13 patients with mediastinal pancreatogenic pseudocysts. There was no pre-selection or distribution into groups. All patients underwent a comprehensive examination, including ultrasound, CT, and MRCPG. Endoscopic retrograde cholangiopancreatography was not performed due to the procedure’s complexity and potential for severe complications. Depending on the nature of the pancreatic pathology and its complications, a combination of conservative and surgical treatment methods was selectively employed.Results. A total of 570 patients (59.7 %) received conservative treatment, while 385 patients (40.3 %) underwent surgical procedures, subdivided into resection, internal drainage, and external drainage. 121 patients (31.4 %) had a resection, including pancreatoduodenal resection (17), Frey’s operation (74), caudal resections (21), and others (9). 33 patients (8.6 %) underwent internal drainage operations, including the Puestow operation (15), hepaticojejunostomy (7), and others (11). Additionally, 231 cyst-related procedures were performed: Frey’s operation (7), cystojejunostomy (12), cystectomy (11), urgent laparotomy (15), and external drainage under ultrasound guidance (186). Of the 156 resection-drainage operations, Frey’s surgery was the most frequent (81 patients; 51.9 %). The postoperative mortality rate was 0.8 %.Conclusion: Surgical indications should be determined based on clinical presentation and diagnostic methods, prioritizing organ preservation whenever possible. The treatment of complicated pseudocysts should be tailored to each patient, emphasizing minimally invasive interventions. External-internal drainage of pancreato-digestive anastomoses through the proximal section of the isolated jejunum is recommended.