Modern drainage interventions in the surgical treatment pancreatic cyst

Abstract

Purpose. To evaluate the capabilities of modern minimally invasive interventions under the beam guidance in the surgical treatment of pancreatic cysts.

Materials and Methods. The results of the examination and treatment of 88 patients with pancreatic cysts. Percutaneous puncture drainage under ultrasonographic guidance holds 56 patients, endoscopic transmural drainage of cysts by ultrasonography—- in 32.

Results. After performing percutaneous drainage of cysts positive results were observed in 42 (75,0%) patients. Relapses cystic formations were observed in 14 (25.0%) patients. Endoscopic transmural drainage under ultrasonography noted one intraoperative complication — perforation of the stomach wall. 6 patients had a good result. Term follow up of patients ranged from 10 months to 3 years.

During endoscopic transmural drainage stent dislocation and relapse of cysts were not detected in all operated patients after 6 months, Long-term results were observed only in 11 patients.

Conclusions. Percutaneous external drainage of pancreatic cysts is an effective intervention in 75% of patients. A fairly high percentage (25%) of relapses is due to the fact that long-term external drainage do not allow to achieve complete obliteration of the cyst cavity in its connection with the main pancreatic duct and preservation of ductal hypertension of the pancreas. Endoscopic installation of a stent between the hand cavity and the lumen of the stomach allows you to create conditions for a constant outflow of cyst contents into the stomach and eliminate pancreatic hypertension. The effectiveness of internal drainage is determined by the duration of stent functioning, as well as the possibility of forming an internal cystogastric fistula (3 figs, bibliography: 8 refs).

Keywords

drainage / minimally invasive intervention / pancreatic cysts

References

[1] Bakulev A. N., Vinogradov V. V. Clinic and surgical treatment of pancreatic cysts. Khirurgiya. 1952; 2: 22–32. Russian (Бакулев А. Н., Виноградов В. В. Клиника и хирургическое лечение кист поджелудочной железы. Хирургия. 1952; 2: 22–32).

[2] Howard J. M., Jordan G. L. Surgical disease of the Pancreas. Philadelphia: Lippincott; 1960. 370.

[3] Vinogradov V. V., Danilov M. V. Cysts of the pancreas. Tashkent: Meditsina Publishe; 1975. 132. Russian (Виноградов В. В., Данилов М. В. Кисты поджелудочной железы. Ташкент: Медицина; 1975. 132).

[4] Shchastny A. T. Pancreatic pseudocysts: diagnosis and treatment. Novosti khirurgii. 2009; 17 (1): 143–56. Russian (Щастный А. Т. Псевдокисты поджелудочной железы: диагностика, лечение. Новости хирургии. 2009; 17 (1): 143–56).

[5] Barthet M., Bugallo M., Moreira L. S., Bastid C., Sastre B., Sahel J. Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients. Gastroenterol. Clin. Biol. 1993; 17: 270–6.

[6] Danilov M. V., Fedorov V. D. Pancreatic surgery: a guide for physicians. Moscow: Meditsina Publisher; 1995. 512. Russian (Данилов М. В., Федоров В. Д. Хирургия поджелудочной железы: Руководство для врачей. М.: Медицина; 1995. 512).

[7] Hookey L. C., Debroux S., Delhaye M., Arvanitakis M., Le Moine O., Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest. Endosc. 2006; 63 (4): 635–43.

[8] Varadarajulu S., Wilcox C. M., Latif S., Phadnis M., Christein J. D. Management of pancreatic fluid collections: a changing of the guard from surgery to endoscopy. Am. Surg. 2011; 77 (12): 1650–5.

RIGHTS & PERMISSIONS

Lazutkin M.V., Ivanusa S.Y., Shershen D.P., Popov A.A.