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Diagnosis and surgical treatment of chronic calculouse pancreatitis

Author: Anatol Vasile Сazac
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council:


The thesis was presented on the 25 March, 2005
Approved by NCAA on the 21 April, 2005


Adobe PDF document1.01 Mb / in romanian


The aim of study was to establish the methods directed to improving the results of diagnosis and complex surgical treatment of patients with chronic calculouse pancreatitis (CCP).

In dissertation is analyzed the experience of complex treatment of 105 patients with CCP with intraductal hypertension during the period 1989 – 2004. Among these patients 84 (80%) were male and 21 (20%) – female, the patient’s age varied from 17 to 65 years, mean age – 45 years.

Contemporary diagnostical algorithm, which included clinico-laboratory investigations, abdominal X-ray, duodenal radiography with barium, ultrasound, fibrogastroduodenoscopy, ERCPG, CT, MRI was proposed.

The indications for surgical treatment were following: CCP with hypertension in Wirsung duct with severe pain resistant to conservative management – in 105 (100%) patients, CCP with hypertension in Wirsung duct – in 43 (40,95%) patients (I group), CCP with hypertension in Wirsung duct, pancreatic cysts – in 62 (59,05%) patients (II group), obstructive jaundice caused by pancreatic pathology – in 11 (10, 47%) cases. Pancreatojejunoanastomosis on the loop by Roux was performed in 42 (40,0%) cases, pancreatojejunostomy on the Omega loop – in 1 (0,95%) case. In 50 (47,62%) cases was performed cystopancreatojejunoanastomosis. The syndromes of Wirsung and biliary hypertension indicated the application of longitudinal pancreatojejunostomy and cholecystojejunostomy (holedocojejunostomy) with using of split Roux loop in 11 (10,58%) cases. Operation Du Val was performed in 1 (0,95%) case. Postoperative complications were recorded in 17,1% cases. Insufficiency of pancreatojejunoanastomosis with forming of pancreatic and small bowel fistulas was established in 1 case. Conservative management was successfull.

As a result of surgical treatment in 95 (96,2%) cases disappeared or considerably decreased pain syndrome, were managed obstructive jaundice and duodenal obstruction. 71 (72,41%) patients continued their professional activity after surgery. Postoperative lethality wasn’t recorded.

The success of surgical treatment is determined by correctly selected method of treatment, which depends from individual conditions in every case. Drainage operations are the operations of choise at CCP with hypertension in Wirsung duct, which allow to restore outflow of a secret pancreas in digestive tract and are more accomplished in postoperative rehabilitation of the patients, but require careful preoperative selection of the candidates.