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      • Pancreaticojejunostomy, Hepaticojejunostomy and Double Roux-En-Y Digestive Tract Reconstruction for Benign Biliary Obstruction and Chronic Pancreatitis

        ( Bo Bo Htay ),( Myat Su Mon Soe ),( Aye Min San ),( Myo Myat Thu ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

        Aims: Biliary obstruction due to chronic pancreatitis is not uncommon. Moreover, the patients with chronic pancreatitis sometimes have biliary stones diseases. The pain due to chronic pancreatitis need to be addressed while treating biliary obstruction. Biliary and pancreatic stenting in these conditions require repeated changing of the stents with multiple admissions, and the long-term success rate is low. Methods: This is a retrospective analysis of five cases of chronic pancreatitis with benign biliary obstruction. Pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction were performed in all patients. Four patients had pancreatic duct dilatation with stones, and cystic dilatation of the duct with distal CBD compression in pancreatic head region found in one patient. Longitudinal pancreaticojejunostomy performed in four patients, and distal pancreatectomy and end-to-side pancreaticojejunostomy done in one patient. Biliary stricture due to chronic pancreatitis was found in three patients, and multiple stones in both intra and extrahepatic ducts found in one patient whom additional subcutaneous access loop was created for future removal of stones. Results: The recovery of all patients was uneventful and no complication such as leakage and digestive tract obstruction occurred in the postoperative period. All patients did not complaint of pain during follow-up visits. One patient needed read mission to medical ward for pancreatic endocrine insufficiency. Conclusions: Surgery is the best option for chronic pancreatitis with biliary obstruction. For the good-risk patients and for the patients with failed endoscopic procedures, double Roux-en-Y digestive tract reconstruction is effective alternative surgical treatment modality where Frey procedure is not appropriate.

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