Postoperative Complications of Beger Procedure

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pancreatic Diseases

Background:

• Chronic pancreatitis (CP) is an inflammatory condition leading to pancreatic dysfunction.
• Treatment options range from conservative management to surgical interventions.
• The Beger procedure (duodenal-preserving pancreatic head resection) is a surgical option for CP.

Purpose of the Study:

• To present a case of unusual complications following a duodenal-preserving pancreatic head resection (DPPHR).
• To discuss the management of refractory pain and intraductal pathology post-Beger procedure.
• To emphasize the importance of vigilant postoperative follow-up for CP patients.

Main Methods:

• A 36-year-old male with diagnosed CP and heavy alcohol history underwent a DPPHR.
• Postoperative refractory pain led to diagnostic imaging and a second surgical intervention.
• Intraoperative findings included pancreatic duct stones, protein plugs, and anastomosis stricture, necessitating revision surgery.

Main Results:

• The patient developed refractory pain three months post-Beger procedure.
• Imaging revealed pancreatic duct stones and intestinal dilation.
• Revision surgery identified protein plugs and pancreaticojejunal anastomosis stricture, which were addressed, leading to recovery.

Conclusions:

• Pancreatic duct and anastomosis strictures are rare but significant complications of the Beger procedure.
• These strictures can cause refractory pain and intraductal pathology.
• Close outpatient follow-up is crucial for early detection and management of postoperative complications after DPPHR.