Laparoscopic management of pancreatic pseudocyst: a prospective study

Pravin D. Bhingare; Sanjay D. Dakhore; Sunil B. Wankhade; Saurabh Lihitkar

doi:10.18203/2349-2902.isj20191264

Authors

Pravin D. Bhingare Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
Sanjay D. Dakhore Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
Sunil B. Wankhade Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
Saurabh Lihitkar Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191264

Keywords:

Pancreatic pseudocyst, Laparoscopic techniques, Cystojejunostomy, Outcome

Abstract

Background: Pancreatic pseudocysts can be defined as localized fluid collections that have a nonepithelialized wall consisting of fibrous and granulation tissue. These pseudocysts usually appear several weeks after the onset of pancreatitis. Advancement in the management of pseudocyst with laparoscopic drainage provides a good alternative or supplement to the surgical treatment of pancreatic pseudocyst. The purpose of this study is to evaluate the feasibility, effectiveness and outcome of Laparoscopic drainage.

Methods: It was a prospective interventional hospital based study carried out among 32 indoor cases of pancreatic pseudocysts operated using laparoscopic procedures admitted under department of general surgery in a tertiary healthcare teaching institute during study period. Cases of pancreatic pseudocysts were evaluated with detailed history, clinical signs and symptoms, the duration and investigations. Details of laparoscopic, its indications, peculiarities, complications rates, recurrence rate and outcome was analyzed.

Results: Single and multiple pancreatic pseudocysts were found in 26 (81.25%) and 6 (18.75%) patients and the most common site was found to be body of pancreas (59.37%). Obstructive jaundice (18.50%) and gastric outlet obstruction (15.63%) were the most common complications seen. The common procedures undertaken in the studied cases were laparoscopic cystogastrostomy (65.62%) followed by laparoscopic cystojejunostomy (12.50%) and laparoscopic external drainage (12.50%). Common complications in studied cases were found to be pain (15.65%), fever (12.5%) and external fistula (6.25%).

Conclusions: Laparoscopic technique for treatment of pancreatic pseudocysts is safe, efficacious, feasible and is associated with fast recovery. These techniques should be preferred over open surgical drainage.

Metrics

Metrics Loading ...

References

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

Sanfey H, Aguilar M, Jones RS. Pseudocysts of the pancreas, a review of 97 cases. Am Surg. 1994;60:661–8.

Keenan DJ, McIlrath EM, Johnston GW, Kennedy TL. Pseudocyst and abscess of the pancreas. Ulster Med J. 1980;49(2):173-80.

Udeshika WAE, Herath HMMTB, Dassanayake SUB, Pahalagamage SP, Kulatunga A. A case report of giant pancreatic pseudocyst following acute pancreatitis: experience with endoscopic internal drainage. BMC Res Notes. 2018;11(1):262.

Hammel P, Levy P, Voitot H, Levy M, Vilgrain V, Zins M, et al. Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology. 1995;108:1230–5.

Lerch MM, Stier A, Wahnschaffe U, Mayerle J. Pancreatic pseudocysts: observation, endoscopic drainage, or resection? Dtsch Arztebl Int. 2009;106(38):614-21.

Podgurski L, Hou G, Shaffer K. CT Imaging of a Pancreatic Pseudocyst: Clinical and Anatomic Implications. Radiol Case Rep. 2015;2(4):107.

Xiao B, Zhang XM. Magnetic resonance imaging for acute pancreatitis. World J Radiol. 2010;2(8):298-308.

Cheruvu CV, Clarke MG, Prentice M, Eyre-Brook IA. Conservative treatment as an option in the management of pancreatic pseudocyst. Ann R Coll Surg Engl. 2003;85(5):313-6.

Martínez-Ordaz JL, Toledo-Toral C, Franco-Guerrero N, Tun-Abraham M, Souza-Gallardo LM. [Surgical treatment of pancreatic pseudocysts]. Cir Cir. 2016;84(4):288-92.

Pan G, Wan MH, Xie KL, Li W, Hu WM, Liu XB, et al. Classification and Management of Pancreatic Pseudocysts. Medicine (Baltimore). 2015;94(24):960.

Sileikis A, Beiša A, Zdanytè E, Jurevičius S, Strupas K. Minimally invasive management of pancreatic pseudocysts. Wideochir Inne Tech Maloinwazyjne. 2013;8(3):211-5.

Aghdassi AA, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM. Pancreatic pseudocysts--when and how to treat? HPB (Oxford). 2006;8(6):432-41.

Crisanto-Campos BA, Arce-Liévano E, Cárdenas-Lailson LE, Romero-Loera LS, Rojano-Rodríguez ME, Gallardo-Ramírez MA, et al. Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City. Rev Gastroenterol Mex. 2015;80(3):198-204.

Khaled YS, Malde DJ, Packer J, Fox T, Laftsidis P, Ajala-Agbo T, et al. Laparoscopic versus open cystgastrostomy for pancreatic pseudocysts: a case-matched comparative study. J Hepatobiliary Pancreat Sci. 2014;21(11):818-23.

Simo KA, Niemeyer DJ, Swan RZ, Sindram D, Martinie JB, Iannitti DA. Laparoscopic transgastric endolumenal cystogastrostomy and pancreatic debridement. Surg Endosc. 2014;28(5):1465-72.

Hauters P, Weerts BN. Laparoscopic treatment of pancreatic pseudocysts. Surg Endosc Other Interv Tech Novemb. 2017;18(11):1645–8.

Park A SR. Laparoscopic pancreatic surgery. Am J Surg. 1999;177:158–63.

Hamza N, Ammori BJ. Laparoscopic drainage of pancreatic pseudocysts: a methodological approach. J Gastrointest Surg. 2010;14(1):148-55.

Mori T, Abe N, Sugiyama M, Atomi Y. Laparoscopic pancreatic cystgastrostomy. J Hepatobiliary Pancreat Surg. 2002;9(5):548-54.