[Chronic pancreatitis of biliary origin. Certain aspects of diagnosis and surgical treatment]

Chronic pancreatitis of biliary origin, frequently localized in the cephalic segment, are generally dependent on the etiopathogeny of the biliary affection, the evolution of which is complicated by their presence. They have a less severe prognosis and in the large majority of cases they are reversible following radical surgical solution of the pathologic biliary component. The study was concerned with 90 cases of which 67 were associated to biliary lithiasis, 9 to non-lithiasic cholecystopathies and 14 were associated to chronic postoperative pancreatitis (of which 6 were lithiasic). The diagnosis were established only during surgey, by coroboration of surgical, cholangiographic and instrumental data. The surgical attitude developed according to results obtained by pre-and intra-operative examination, with the aspect of biliopancreatic lesions, preference being given to radical and decompressive interventions. Simple cholecystectomy was justified in only 27 cases while in 47 other cases it was associated with choledocotomy, in 19 cases with external biliary drainage, with choledocoduodenostomy in 27 cases, with oddian sphincteroplasty in 8 cases, with oddian sphincteroplasty associated to Wirsung duct sphincteroplasty in 5 cases and with choledocojejunostomy in one case. In 2 patients right splanchnicectomy was carried out. The postoperative results were very good in 41 cases, good in 33, mediocre in 13 and unsatisfactory in one case. Two patients died.