Treatment strategy for complicated pancreatic pseudocysts

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OBJECTIVE

To analyze an effectiveness of various surgical approaches for complicated pancreatic pseudocysts.

MATERIAL AND METHODS

The results of surgical treatment were analyzed in 188 patients with complicated pancreatic pseudocysts. The study included patients with one of complications of pseudocyst (infection, bleeding, compression of adjacent organs, perforation). Depending on surgical treatment, patients were divided into 2 groups: the 1^st group (76 patients) — laparotomy followed by certain open surgery, the 2^nd group (112 patients) — various minimally invasive treatments without further open operations.

RESULTS

Effectiveness of surgical treatment was analyzed considering incidence of complications (postoperative wound suppuration, pneumonia, sepsis, multiple organ failure) and mortality. In the 1^st group, postoperative wound suppuration — 22 (29%) patients, pneumonia — 17 (22.4%), sepsis — 14 (18.4%) patients, multiple organ failure — 14 (18.4%), 15 (19.8%) patients died. In the 2^nd group, these values significantly differed: postoperative wound suppuration — 9 (8%), pneumonia — 5 (4.3%), sepsis — 1 (0.9%), multiple organ failure — 4 (3.5%), 1 (0.9%) patient died.

CONCLUSION

Minimally invasive measures are the most optimal for any complication of pancreatic pseudocyst. Laparotomy is indicated if minimally invasive intervention is impossible for certain reason. It is advisable to concentrate these patients in specialized centers.

Keywords:

pancreatic pseudocyst

perforation

compression

infection

bleeding

minimally invasive intervention

Authors:

Nevelskiy V.V.

Saint Petersburg «RZD-Medicine» Clinical Hospital

Goltsov V.R.

Saint Petersburg «RZD-Medicine» Clinical Hospital;
Dzhanelidze Research Institute for Emergency Care

Received:

15.12.2020

Accepted:

20.01.2021

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