Comparative analysis of the results of surgical treatment of chronic capitalated pancreatitis

Purpose of a study: to compare the immediate and long-term outcomes of various surgical treatment options for patients with chronic pancreatitis primarily affecting the head of the pancreas.

Material and Methods. In the period of 2018–2022, the outcomes of various surgical treatment options were analyzed in 80 patients with pancreatic head pancreatitis. Patients were divided into three groups based on the type of surgery: group 1 ( n = 24) patients who underwent drainage procedures (Roux-en-Y longitudinal pancreatojejunostomy); group 2 ( n = 27) patients who underwent the Frey procedure; group 3 ( n = 29) patients who underwent subtotal pancreatectomy with longitudinal pancreatojejunostomy using an original technique.

Results . The highest frequency of postoperative complications was noted after the Frey operation 8 (29.6)% in comparison with drainage interventions and the original technique: 4 (16.7) % and 4 (13.8)%, respectively. The structure of complications was dominated by pancreatic fistulas 6 (22.2 ) %, post-resection bleeding 4 (14.8) %, acute pancreatitis 2 (7.4) %. The introduction of the original resection and drainage method made it possible to reduce the frequency of pancreatic fistulas from 22.2 (8.6; 42.3) % (2[nd] group) to 3.4 (0.1; 17.8)% ( p < 0.001). When analyzing the long-term results, the highest rate of disease recurrence (8% (33.3 (15.6; 55.3) cases) and the worst quality of life indicators (MOC SF-36) were noted after drainage interventions ( p < 0.001); no statistically significant differences were found between patients in 2[nd] and 3[rd] groups.

Conclusion . A differentiated approach to the choice of surgical intervention, taking into account morphological changes in the parenchyma of the gland, allows us to determine the indications for surgical treatment. The original technique of duodenum-preserving pancreatectomy is the optimal intervention for chronic capitate pancreatitis, which makes it possible to reliably reduce the incidence of specific postoperative complications and improve longterm treatment outcomes.

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