Surgical Strategy and Prediction of Early Postoperative Complications After Proximal Pancreatectomy in Chronic Pancreatitis

Abstract

Background. The advances in surgical treatment of chronic pancreatitis (CP) have significantly reduced postoperative mortality rate, however, the number of deaths remains high. Thus, prevention and prediction of complications are regarded as a complex and important task in choosing optimal surgical strategy. Objective. To study early postoperative complications after proximal pancreatic resection in chronic pancreatitis; to determine surgical strategy in preoperative and postoperative stages to reduce the risk of and predict postoperative complications. Material and methods. From 2001 to 2019 on the basis of the Vitebsk Regional Clinical Hospital, 246 patients with CP and its complications were operated on, among them there were 223 (90.7%) men and 23 (9.3%) women. The mean age was 48(±6) years. Our study did not include patients who underwent Frey's operation and pancreatoduodenal resection due to their small number. Results. Of 246 operated patients, early postoperative complications occurred in 126 (51.2%) patients. Among them after the Beger’s operation - in 77 (31.2%) patients, after the Berne modification of the Beger’s operation - in 49 (20%) patients, respectively. Of the 126 patients with developed postoperative complications, repeated surgical interventions were performed in 50 (39.7%) patients - 35 (70%) patients after the Beger’s operation and 15 (30%) patients after the Berne modification of the Beger’s operation, respectively; in 76 (60, 3%) patients, postoperative complications were controlled by conservative measures. In order to manage early postoperative complications, various types of surgical interventions were performed. Conclusions. Patients with pancreatic calcification, virsungectasia, virsungolithiasis in combination with portal hypertension are more likely to develop early postoperative complications during the Beger’s operation, in comparison with the Berne modification of the Beger’s operation. In patients with pancreatic calcification, virsungectasia and virsungolithiasis in combination with portal hypertension, as well as in patients with pancreatic head cysts, it is advisable to perform the Berne modification of the Beger’s operation, it being technically simpler thus allowing to minimize the number of postoperative complications. When performing the Beger’s operation, as compared to the Berne modification of the Beger’s operation, there were no statistically significant differences in the total number of repeated interventions aimed to correct early postoperative complications, however, after the Beger’s operation, the complications were statistically significantly more often managed by minimally invasive intervention (p=0.005).