Surgical treatment for biliary obstruction in patients with painful chronic pancreatitis and a dilated duct: choledochojejunostomy or biliopancreatic tunneling?

Patients with painful chronic pancreatitis and a dilated duct are treated with extended surgical drainage procedures such as Frey or extended Partington procedures. In cases of biliary obstruction, an additional biliary derivation is performed. Either concurrent choledochojejunostomy or biliopancreatic tunneling may be chosen in such cases. To assess the results of surgical treatment for biliary obstruction in patients with painful chronic pancreatitis and a dilated main pancreatic duct. This study was a case series comprising patients with chronic pancreatitis who underwent an extended drainage procedure combined with a biliary derivation including choledochojejunostomy or biliopancreatic tunneling. From December 2020 to July 2023, 58 patients underwent extended pancreatic duct drainage for chronic pancreatitis. Among them, eight patients (14%) had biliary obstruction. Three patients (38%) underwent concurrent choledochojejunostomy, whereas five patients (62%) underwent biliopancreatic tunneling. One patient (20%) in the group of biliopancreatic tunneling experienced a complication (Grade II), compared to no patient in the group of choledochojejunostomy. Another patient (20%) in the group of biliopancreatic tunneling developed recurrent biliary obstruction, compared to no patient in the group of choledochojejunostomy. Pain relief, quality of life, pancreatic function, and other outcomes did not differ between the two groups. Both choledochojejunostomy and biliopancreatic tunneling were effective in treating biliary obstruction due to chronic pancreatitis. However, careful execution of biliopancreatic tunneling is critical to avoid recurrent biliary obstruction.