Possibility of prognostication for unfavorable results of the pancreaticoduodenal resection on background of the obturation jaundice syndrome

Abstract

Objective. To determine the possibility of prognostication of unfavorable course of postoperative period in the aspect of the planned pancreaticoduodenal resection for focal affection of pancreaticoduodenal zone on background of obturation jaundice. Materials and methods. The pancreatic head cancer was verified in 174 (64.0%) patients, cancer of the duodenal papilla magna - in 20 (7.4%), cancer of distal hepaticocholedochus - in 24 (8.8%), chronic pseudotumoral pancreatitis - in 54 (20.0%) patients. In the main group (112 patients) preparation to operative intervention was conducted in accordance to elaborated algorithm, and in a control group (160 patients) - in accordance to conventional standards. Results. Pancreaticoduodenal resection with formation of termino-lateral anastomosis in accordance to Whipple procedure was performed in 38 (14.0%) patients, termino-terminal anastomosis in accordance to procedure of Shalimov-Kopchak - in 40 (14.7%), ductomucous pancreaticojejunoanastomosis - in 127 (46.7%), pancreaticogastroanastomosis with invagination of the pancreatic stump into the gastric stump - in 35 (12.9%), pancreaticogastrostomy with deepening of the pancreatic stump into the sleeve, made of the big gastric curvature - in 32 (11.8%). Insufficiency of pancreaticodigestive anastomosis have occurred in 32 (11.8%) patients. Mortality have constituted 5.1%.

Keywords

• prognostication; bilary decompression; pancreaticoduodenal resection; pancreatic gland; obturation jaundice; anastomosis