Conservative management versus surgical drainage in pancreatic pseudocyst

Abdullah Almaihan; Ahmed Matar; Eman Murshid; Sama Al-Ostaz; Ahmed Shebly; Mohammed Miftah; Eman Alsaif; Doaa Alzaher; Hadi Alyami; Fetoun Al-Ajmi

doi:10.18203/2349-2902.isj20182438

Authors

Abdullah Almaihan Department of Surgery, Prince Saud bin Jalawy Hospital, Al-Hofuf, Saudi Arabia
Ahmed Matar Department of Surgery, King Khaled Hospital and Prince Sultan Center For Health Care, Al-Kharj, Saudi Arabia
Eman Murshid College of Medicine, Ibn Sina National College, Jeddah, Saudi Arabia
Sama Al-Ostaz College of Medicine, Batterjee Medical College, Jeddah, Saudi Arabia
Ahmed Shebly College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
Mohammed Miftah College of Medicine, Jazan University, Jazan, Saudi Arabia
Eman Alsaif College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam, Saudi Arabia
Doaa Alzaher College of Medicine, Medical University of Warsaw, Warsaw, Poland
Hadi Alyami College of Medicine, Najran University, Najran, Saudi Arabia
Fetoun Al-Ajmi College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia

DOI:

https://doi.org/10.18203/2349-2902.isj20182438

Keywords:

Advantages, Complications, Conservative management, Disadvantages, Outcome, Pancreatic pseudocyst, Surgical drainage

Abstract

Pancreatic pseudocyst is not an uncommon complication of acute or chronic pancreatitis. It often presents with persistent abdominal pain and tenderness after the resolution of pancreatitis. Two lines of management are available for treatment of pancreatic pseudocyst: conservative management and surgical drainage. Conservative management is preferred in small-sized, asymptomatic, and short-lasting pseudocysts, whilst surgical management is often indicated when the cysts are larger in size, symptomatic, long-lasting, or when complications occur. Overall, 50% of cysts resolve spontaneously and only require conservative management, whilst surgical management is indicated for prevention of potential complications. This article will review and discuss in detail and compare between conservative management and surgical drainage of pseudocyst as regards indications, advantages, disadvantages, outcomes, and complications.

Metrics

Metrics Loading ...

References

Imrie CW, Buist LJ, Shearer MG. Importance of cause in the outcome of pancreatic pseudocysts. Am J Surg. 1988;156(3):159-62.

Barthet M, Bugallo M, Moreira LS, 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(4):270-6.

Habashi S, Draganov P V. Pancreatic pseudocyst. World J Gastroenterol. 2009;15(1):38-47.

Delgado RA, Elías JP, Calleja EA, Martínez-Pardo NG, Esteban JI. Pancreatic pseudocyst: less is more. Cir Pediatr. 2009;22(2):55-60.

Kim YH, Saini S, Sahani D, Hahn PF, Mueller PR, Auh YH. Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst. Radiographics. 2005;25(3):671-85.

Levy MJ, Baron TH. Pseudocyst Management. In: Successful Training in Gastrointestinal Endoscopy. Chapter 28. 201;332-340.

Khanna AK, Tiwary SK, Kumar P. Pancreatic pseudocyst: Therapeutic dilemma. Int J Inflam. 2012;2012.

Jones DR, Vaughan RA, Timberlake GA. Pancreatic pseudocyst: Diagnosis and management. South Med J. 1992;85(7):729-34.

Mulligan C, Howell C, Hatley R, Martindale R, Clark J. Conservative management of pediatric pancreatic pseudocyst using octreotide acetate. Am Surg. 1995;61(3):206-09.

Nugent CE, Lehman GA, Madura JA, Kopecky K. Pancreatic cancer presenting with resolving pseudocyst during octreotide therapy. Pancreas. 1993;8(4):506-09.

Vitas GJ, Sarr MG. Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery. 1992;111(2):123-30.

Kaban GK, Perugini RA, Czerniach DR, Litwin DEM. Pancreatic pseudocyst drainage. Oper Tech Gen Surg. 2004;6(1):55-62.

Urakami A, Tsunoda T, Kubozoe T, Takeo T, Yamashita K, Imai H. Rupture of a bleeding pancreatic pseudocyst into the stomach. J Hepatobiliary Pancreat Surg. 2002;9(3):383-85.

Solheim K, Haarberg G, Skjennald A, Rynning SE, Soreide O, Jensen D. Severe hemorrhage in pancreatic pseudocyst. Alvorlig blodning ved Pancreascyste. 1991;111(13):1616-18.

Vitale GC, Lawhon JC, Larson GM, Harrell DJ, Reed DN, MacLeod S. Endoscopic drainage of the pancreatic pseudocyst. Surgery. 1999;126(4):616-23.

Sharma D, Kataria S, Pathak R, Barua B, Lal R. Laparoscopic drainage of a large pancreatic pseudocyst. J Soc Laproendo Surg. 2012;16(4):675-77.

Frey CF. Pancreatic pseudocyst-operative strategy. Ann Surg. 1978;188(5):652-62.

Roeder BE, Pfau PR. Endoscopic pancreatic pseudocyst drainage. Tech Gastrointest Endosc. 2005;7(4):211-18.

Yemos K1, Laopodis B, Yemos J, Scouras K, Rissoti L, Lainas A, et al. Surgical management of pancreatic pseudocyst. Minerva Chir. 1999;54(6):395-402.

Afzal M, Ghous SG, Siddiq K. Spontaneous rupture of pancreatic pseudocyst. J Coll Physicians Surg Pakistan. 2004;14(6):370-71.

Ungania S, Panocchia N. Splenic artery rupture in pancreatic pseudocyst. Rottura di Arter splenica Pseudocisti Pancreatica. 2000;71(2):251-55.

Accetta P, Accetta I, Accetta R, Campos KB, Rodrigues MFO. Pancreatic pseudocyst with splenic involvement. Case report. Rev Col Bras Cir. 2010;37(6):457-59.

Botianu PV, Dobre AS, Botianu AM, Onisor D. Pancreatic pseudocyst with splenic artery erosion, retroperitoneal and splenic hematoma. Case Rep Surg. 2015;2015:1-4.

Bhasin DK, Rana SS, Sharma V, Rao C, Gupta V, Gupta R, et al. Non-surgical management of pancreatic pseudocysts associated with arterial pseudoaneurysm. Pancreatology. 2013;13(3):250-53.

Miskic D, Pitlovic V, Latic F, Samardzic J, Miskic B, LaticHodzic L. Laparoscopic transgastric gastrocystostomy pancreatic pseudocyst. Med Arch. 2011;65(6):371-72.

Wagh J. Surgical drainage of multiple pancreatic pseudocyst. Pancreatology. 2014;14(2):S2-S3.

Zhao X, Feng T, Ji W. Endoscopic versus surgical treatment for pancreatic pseudocyst. Dig Endosc. 2016;28(1):83-91.

Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterol. 2013;145(3):583-90.

Aljarabah M, Ammori BJ. Laparoscopic and endoscopic approaches for drainage of pancreatic pseudocysts: A systematic review of published series. Surg Endoscop. 2007:21(11):1936-44.

Oida T, Mimatsu K, Kano H, Kawasaki A, Kuboi Y, Fukino N, et al. Laparoscopic cystogastrostomy via the posterior approach for pancreatic pseudocyst drainage. Hepatogastroenterol. 2011;58(110-111):1771-5.