Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension
Journal of Surgery
Volume 3, Issue 4, August 2015, Pages: 32-38
Received: Jun. 29, 2015;
Accepted: Jul. 6, 2015;
Published: Jul. 17, 2015
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Aliaksandr Varabei, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
Anatoli Shuleika, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
Yury Vizhinis, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
Yury Arlouski, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
Natalia Lagodich, Minsk Regional Clinical Hospital, Endoscopy Unit, Minsk, Belarus
Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser and double balloon enteroscopy (DBE) technologies for its relief. Materials and methods: Pancreatojejunoanastomosis (PJA) lumen was examined using the videoenteroscope EN-450P5/20 (Fujifilm group, Fujinon Co, Tokio, Japan) for the first time in the world. All 20 patients had had CP and underwent an elective surgery earlier. During 2010-2014, 198 resections were performed, with 159 (80,3%) being laser drainage procedures. Results: DBE revealed strictures of PJA and open common bile duct, residual pancreatoliths in PJA lumen, and PJA leakage. After DBE laser lithotripsy of pancreatoliths in tributary ducts, a free outflow of pancreatic juice from the lumen was obtained. DBE findings were supported by the morphological study of excised pancreatic specimen, CT-scans before the surgery and the staining of PJA lumen. All these data suggest that 17,7% of CP patients along with magistral ductal hypertension had peripheral ductal hypertension (PDH), which seems to be a new cause of severe abdominalgia. The latter arises when pancreatoliths block the orifices of tributary ducts. For reducing the PDH, we have developed a new surgical procedure named «laser cylindric wirsungectomy» (n=26) and proposed our own classification of pancreatic duct stones. Conclusions: DBE has great opportunities for the diagnosis of complications and their mini-invasive treatment after pancreatojejunostomy (PJ). Laser technologies are considered to be a new approach to the effective open and mini-invasive surgical treatment of CP.
Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension, Journal of Surgery.
Vol. 3, No. 4,
2015, pp. 32-38.
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