# Intrapancreatic Biliary Ductoplasty for Chronic Pancreatitis-Induced Biliary Stricture: Outcome Analysis of a Novel Surgical Technique

## TL;DR

This study evaluates a new surgical technique for treating biliary blockage caused by chronic pancreatitis, showing it is safe and effective with low complication rates.

## Contribution

The study introduces and validates intrapancreatic biliary ductoplasty as a novel surgical approach for managing chronic pancreatitis-induced biliary stricture.

## Key findings

- The procedure had a 12% postoperative complication rate and a median hospital stay of eight days.
- Only 2% of patients experienced recurrent biliary stricture during a median follow-up of 29 months.
- The technique showed comparable safety and effectiveness to existing standard procedures.

## Abstract

Background: Biliary obstruction is one of the common complications of chronic pancreatitis (CP). Different operative procedures were described for its management. The present study describes the technique and outcome analysis of intrapancreatic biliary ductoplasty for CP-induced biliary stricture.

Methods: From March 2014 to March 2021, patients who underwent Frey's procedure with biliary ductoplasty (choledochoplasty) for CP-induced biliary stricture were analyzed retrospectively.

Results: During the study period, 148 patients underwent surgery for CP, of which 49 (33%) patients had associated biliary obstruction. Among the 49 patients with biliary obstruction, 43 patients underwent biliary ductoplasty along with Frey’s procedure. On preoperative evaluation, elevated serum bilirubin and alkaline phosphatase were observed in 38 (88%) and 43 (100%) patients, respectively, and biliary stricture in 33 (77%) patients. The median duration of surgery was 250 minutes, with a median blood loss of 300 mL. Postoperative complications developed in five (12%) patients, with a median hospital stay of eight days. With a median follow-up of 29 months, recurrent biliary stricture was noted in one (2%) patient, and three patients had readmission for abdominal pain.

Conclusion: Intrapancreatic biliary ductoplasty is a safe and feasible alternative procedure in patients with CP and biliary obstruction. This procedure is comparable to existing standard procedures without an increase in morbidity or mortality. This procedure seems to have a good long-term outcome with a low risk of recurrent biliary stricture.