Surgical Management of Chronic Pancreatitis: on the Way to a Specialised Service in Latvia

Abstract

Background Pain irresponsive to conservative treatment, symptomatic pseudocysts, obstruction of the gastrointestinal tract and bile ducts, development of pseudoaneurisms and internal fistulas are complications of chronic pancreatitis that necessitate invasive treatment. The aim of the study was to review the 7-year experience in the treatment of this patient category. Methods Retrospective analysis of the treatment results of the patients with chronic pancreatitis who were treated in our institution between January 2010 and March 2016. Results Out of 450 patients, 26.7% were females and 73.3% males. Alcohol was an etiologic factor in the majority of cases, 44.0%. Association with gallstones was found in 6.4%, with trauma - in 1.1%, however 48% were of unconfirmed etiology. Most patients - 86.4% - suffered from pain. Gastroduodenal obstruction and biliary obstruction was found in 6.2% and 4.7%, internal pancreatic fistulae in 4.7%, pseudoaneurisms in 2% and septic complications in 2.2% of cases. Non-operative management was successful in 62%, while invasive treatment needed 38% of patients. In total, 130 patients were operated on. The Frey procedure was performed in most cases - 46.9%, followed by cystogastro/cystoduodenostomy in 23.8% and other types in 29.3%. The median intensive care unit stay was 3 days IQR 2-4, and hospital stay - 8 days IQR 5-13. The mortality rate in this cohort was 0.4%. Conclusion Surgical intervention is the most common treatment of chronic pancreatitis in our institution. The Frey and Beger procedures and internal drainage are associated with a low complication and mortality rate; however, minimally invasive treatment should be used more often in the future.