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Gupta A, Chennatt JJ, Mandal C, Gupta J, Krishnasamy S, Bose B, Solanki P, H S, Singh SK, Gupta S. Approach to Cystic Lesions of the Pancreas: Review of Literature. Cureus 2023; 15:e36827. [PMID: 37123688 PMCID: PMC10139841 DOI: 10.7759/cureus.36827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Pancreatic cystic lesions (PCL) have a wide range of demographical, clinical, morphological and histological characteristics. The distinction between these lesions is of paramount importance due to the risk of malignancy in specific categories of PCL. Considering the malignant potential for pancreatic cystic neoplasm (PCN) lesions, guidelines have been made to balance unnecessary treatment and manage the progression to malignancy. Various surgical procedures can be done for PCN depending on the location and size of the cyst; pancreatoduodenectomy is done for PCN located in the head of the uncinate process, whereas distal pancreatectomy is done for PCN in the body or tail. In the neck and proximal body of the pancreas, less extensive resections such as central pancreatectomy can be performed. Active surveillance of PCN is typically offered to asymptomatic PCNs of subtype intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) without any concerning features. In recent years, numerous guidelines have been created to augment PCN diagnosis, classification and management. Despite this, the management of PCNs remains complex. Thus, discussions with multidisciplinary teams involving surgeons, gastroenterologists, pathologists, and radiologists are required to ensure optimum care for the patient.
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Nalwa HS, Lanka SP, Mederos R. Giant Pseudocyst of the Pancreas: A Case Report. Cureus 2022; 14:e29456. [PMID: 36299965 PMCID: PMC9587752 DOI: 10.7759/cureus.29456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/05/2022] Open
Abstract
Pancreatic cysts are usually asymptomatic over 70% of the time. They can be benign or malignant. Enhanced imaging modalities and increased usage of routine imaging have increased the identification of pancreatic cysts. If symptomatic, abdominal pain or back pain, unexplained weight loss, jaundice, steatorrhea or palpable mass are usually the presenting complaints. Pancreatic cysts are typically assessed by cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI). In this article, we present a case of a 33-year-old female with a recurrent large pancreatic pseudocyst, initially measured 15.8 cm x 14 cm x 14 cm, who was subsequently admitted to our unit and managed successfully. After undergoing diagnostic laparoscopy, exploratory laparotomy, and pancreatic cystogastrostomy, the pseudocyst shrunk to 8 cm x 6 cm over 13 weeks. It is rare to come across a pseudocyst of such large dimensions. Despite its large size, the patient presented with vague abdominal pain as the only chief complaint. The unusual presentation of symptoms and the enormous size of the pseudocyst make this a unique case. Managing giant pancreatic pseudocysts can be complex, as seen in this scenario by the multiple approaches attempted to treat the pseudocyst.
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He YG, Li J, Peng XH, Wu J, Xie MX, Tang YC, Zheng L, Huang XB. Sequential therapy with combined trans-papillary endoscopic naso-pancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts. World J Clin Cases 2021; 9:6254-6267. [PMID: 34434992 PMCID: PMC8362563 DOI: 10.12998/wjcc.v9.i22.6254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection. AIM To manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome. METHODS One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation via the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups. RESULTS The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group (P < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases). CONCLUSION Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.
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Affiliation(s)
- Yong-Gang He
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Jing Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Xue-Hui Peng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Jing Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Ming-Xun Xie
- Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Yi-Chen Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Lu Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
| | - Xiao-Bing Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
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Abstract
Chronic pancreatitis (CP) should be suspected in the case of recurrent upper abdominal pain of unknown origin and/or clinical signs of exocrine pancreatic insufficiency (EPI). Alcohol is the most common etiological factor associated with CP, others being smoking, male gender, and hereditary forms. CP is often associated with recurrent episodes of acute exacerbations.As of today, there is no accepted clinical definition of CP. However, irreversible morphological changes within the pancreas often occur, including dilatation of the main and branch pancreatic ducts, calcifications in ducts and parenchyma, parenchymal atrophy, and development of pseudocysts, though less so in the early phase of CP.
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Saluja SS, Srivastava S, Govind SH, Dahale A, Sharma BC, Mishra PK. Endoscopic cystogastrostomy versus surgical cystogastrostomy in the management of acute pancreatic pseudocysts. J Minim Access Surg 2019; 16:126-131. [PMID: 30777987 PMCID: PMC7176009 DOI: 10.4103/jmas.jmas_109_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Studies comparing surgical versus endoscopic drainage of pseudocyst customarily include patients with both acute and chronic pseudocysts and the endoscopic modalities used for drainage are protean. We compared the outcomes following endoscopic cystogastrostomy (ECG) and surgical cystogastrostomy (SCG) in patients with acute pseudocyst. Methods: Seventy-three patients with acute pseudocyst requiring drainage from 2011 to 2014 were analysed (18 patients excluded: transpapillary drainage n = 15; cystojejunostomy n = 3). The remaining 55 patients were divided into two groups, ECG n = 35 and SCG n = 20, and their outcomes (technical success, successful drainage, complication rate and hospital stay) were compared. Results: The technical success (31/35 [89%] vs. 20/20 [100%] P = 0.28), complication rate (10/35 [28.6%] vs. 2/20 [10%]; P = 0.17) and median hospital stay (6.5 days [range 2–12] vs. 5 days [range 3–12]; P = 0.22) were comparable in both the groups, except successful drainage which was higher in surgical group (27/35 [78%] vs. 20/20 [100%] P = 0.04). The conversion rate to surgical procedure was 17%. The location of cyst towards tail of pancreas and presence of necrosis were the main causes of technical failure and failure of successful endoscopic drainage, respectively. Conclusion: Surgical drainage albeit remains the gold standard for management of pseudocyst drainage; endoscopic drainage should be considered a first-line treatment in patients with acute pseudocyst considering the reasonably good success rate.
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Affiliation(s)
- Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - S Hari Govind
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Amol Dahale
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Farias GF, Bernardo WM, De Moura DT, Guedes HG, Brunaldi VO, Visconti TADC, Gonçalves CV, Sakai CM, Matuguma SE, dos Santos ME, Sakai P, De Moura EG. Endoscopic versus surgical treatment for pancreatic pseudocysts: Systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14255. [PMID: 30813129 PMCID: PMC6407966 DOI: 10.1097/md.0000000000014255] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). METHODS The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. RESULTS There was no significant difference between treatment success rate (risk difference [RD] -0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD -0.02; 95% CI [-0.04,0.08]; P = .48), general adverse events (RD -0.05; 95% CI [-0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [-0.04,0.07]; P = .58) between surgical and endoscopic treatment.Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI [-5.18, -3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI [-5.43,-3.94]; P < .00001). CONCLUSION There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.
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Affiliation(s)
- Galileu F.A. Farias
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Wanderley M. Bernardo
- Thoracic Surgery Department, Instituto do Coração (InCor, Heart Institute), University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Diogo T.H. De Moura
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | | | - Vitor O. Brunaldi
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Thiago A. de C. Visconti
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Caio V.T. Gonçalves
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Christiano M. Sakai
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Sergio E. Matuguma
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Marcos E.L. dos Santos
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Paulo Sakai
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
| | - Eduardo G.H. De Moura
- Gastroenterology Department, Gastrointestinal Endoscopy Unit, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar
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Abstract
Open surgical intervention for treatment of simple pancreatic pseuodocyst (PP) has a high success rate and has been the historical gold standard. Open surgical intervention, however, confers significant morbidity and mortality, which has spurred the development of less invasive techniques. Laparoscopic approaches are feasible with the potential for lower complication rates and length of stay. The endoscopic approach has the appeal of potentially shorter hospitalization length of stays and does not require general anesthesia. Complicated PPs or those that arise in the setting of chronic pancreatitis warrant additional workup and special consideration.
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Affiliation(s)
- Lea Matsuoka
- Department of Surgery, Vanderbilt University, 801 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA.
| | - Sophoclis P Alexopoulos
- Department of Surgery, Vanderbilt University, 801 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA
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Liu Y, Zhou C, Chen L, Sun Y, He W. [A summary of hip-preservation surgery based on peri-collapse stage of osteonecrosis of femoral head]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1010-1015. [PMID: 29806443 PMCID: PMC8458593 DOI: 10.7507/1002-1892.201611084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 06/15/2017] [Indexed: 12/16/2022]
Abstract
Objective To summarize surgical procedures of hip-preservation based on peri-collapse stage of osteonecrosis of the femoral head (ONFH). Methods The basic points of peri-collapse stage theory was expounded. The related literature on surgical procedures was summarized and analyzed based on the theory. Results Surgical procedures of hip-preservation tend to emphasize on mechanical repair, giving consideration to biological repair. It is consistent with the essence of peri-collapse stage theory, which attaches great importance to biomechanical stability. Conclusion Peri-collapse stage theory has a guiding significance to the choice of surgical timing and approach, and it is one of the important theoretical basis for hip-preservation treatment.
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Affiliation(s)
- Yuhao Liu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The Lab of Orthopaedics and Traumatology, Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Chi Zhou
- The Lab of Orthopaedics and Traumatology, Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;Department of Joint Orthopaedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;National Chinese Medicine Key Specialist of Hip Disease, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Leilei Chen
- The Lab of Orthopaedics and Traumatology, Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;Department of Joint Orthopaedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;National Chinese Medicine Key Specialist of Hip Disease, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Youqiang Sun
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The Lab of Orthopaedics and Traumatology, Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Wei He
- The Lab of Orthopaedics and Traumatology, Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;Department of Joint Orthopaedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;National Chinese Medicine Key Specialist of Hip Disease, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405,
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9
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Zhao X, Feng T, Ji W. Endoscopic versus surgical treatment for pancreatic pseudocyst. Dig Endosc 2016; 28:83-91. [PMID: 26331472 DOI: 10.1111/den.12542] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/14/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM To evaluate the effectiveness and safety of endoscopic treatment for pancreatic pseudocyst compared with surgical treatment. METHODS PubMed and The Cochrane Library were systematically searched to identify all comparative trials investigating endoscopic versus surgical treatment for pancreatic pseudocyst. Main outcome measures included treatment success rate, adverse events, recurrence rate, length of hospital stay and hospital cost. RESULTS Five comparative studies with 255 participants were included in this meta-analysis. The surgical group exhibited a higher treatment success rate than the endoscopic group (OR, 0.43; 95% CI, 0.20-0.95; P = 0.04). However, there was no difference in the rates of adverse events (OR, 0.67; 95% CI, 0.33-1.36; P = 0.27) or recurrence (OR, 1.53; 95% CI, 0.37-6.39; P = 0.56) between the endoscopic and the surgical groups. Evidence from included studies demonstrated that the endoscopic group was associated with shorter length of hospital stay and lower hospital cost compared to the surgical group. CONCLUSION Endoscopic treatment may be the first-line treatment approach for patients with pancreatic pseudocyst.
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Affiliation(s)
- Xin Zhao
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tao Feng
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wu Ji
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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10
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Abstract
BACKGROUND A pancreatic pseudocyst is the collection of pancreatic secretions surrounded by fibrous tissue caused by pancreatic disease that affects the pancreatic duct. Clinical presentation is variable. Management includes percutaneous, endoscopic or surgical drainage and resection. MATERIAL AND METHODS Review of a cohort of patients with pancreatic pseudocyst in a third level hospital. An analysis was performed on the demographic data, aetiology, clinical presentation, radiological and laboratory findings, type of surgical procedure, complications, recurrence and mortality. The statistical analysis was performed using Chi squared and Student t tests, with a p<0.05. RESULTS A total of 139 patients were included, of whom 58% were men and 42% were women, with median age of 44.5 years. Chronic pancreatitis was the most common aetiology, present in 74 patients (53%). The main complaint was abdominal pain in 73% of patients. Median size was 18cm (range 7-29) and the most frequent location was body and tail of the pancreas. Internal surgical drainage was selected in 111 (80%) patients, of whom 96 were cystojejunostomy, 20 (14%) had external surgical drainage, and 8 (6%) resection. Complications were, pancreatic fistula (12%), haemorrhage (4%), infection (4%), and other non-surgical complications (4%). Complication rate was higher if the cause was chronic pancreatitis or if the management was external surgical drainage. Recurrence rate was 6%, and a mortality rate of 1%. CONCLUSION Surgical management is a viable option for the management of pancreatic pseudocyst with a low complication and recurrence rate.
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Marino KA, Hendrick LE, Behrman SW. Surgical management of complicated pancreatic pseudocysts after acute pancreatitis. Am J Surg 2015; 211:109-14. [PMID: 26507289 DOI: 10.1016/j.amjsurg.2015.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/08/2015] [Accepted: 07/25/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Management of pancreatic pseudocysts (PP) is unclear when located in areas outside the lesser sac, infected, or when portal venous (PV) occlusion is present. METHODS Patients having internal drainage of PP. Management and outcome were assessed relative to location, presence of infection, and/or PV occlusion. RESULTS No patient required transfusion, and there were no readmissions in 9 patients with PV occlusion. Eleven patients had infected PP including 5 extending outside the lesser sac. Six had postoperative imaging, 4 readmission, and 3 required adjunct postoperative percutaneous drainage. All but 2 with PP beyond the lesser sac had Roux-en-Y cystjejunostomy including 4 with 2 anastomoses. Nine, 4, and 5 required reimaging, readmission, and postoperative therapeutic intervention, respectively. CONCLUSIONS (1) Open PP drainage in the face of PV occlusion confers a low risk of bleeding and a minimal need for reimaging or readmission; (2) internal drainage of infected PP is a viable option to external drainage; and (3) PP extending beyond the lesser sac can most often be managed successfully by Roux-en-Y drainage but may require additional intervention.
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Affiliation(s)
- Katy A Marino
- Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA
| | - Leah E Hendrick
- Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA
| | - Stephen W Behrman
- Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA.
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12
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Crisanto-Campos BA, Arce-Liévano E, Cárdenas-Lailson LE, Romero-Loera LS, Rojano-Rodríguez ME, Gallardo-Ramírez MA, Cabral-Oliver J, Moreno-Portillo M. Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 80:198-204. [PMID: 26249139 DOI: 10.1016/j.rgmx.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/21/2015] [Accepted: 05/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive management of pancreatic pseudocysts (PP) is currently indicated in those patients with symptoms or complications. Treatment options are classified as surgical (open and laparoscopic) and non-surgical (endoscopic and radiologic). AIM To describe the morbidity, mortality, and efficacy in terms of technical and clinical success of the laparoscopic surgical approach in the treatment of patients with PP in the last 3 years at our hospital center. METHODS We included patients with PP treated with laparoscopic surgery within the time frame of January 2012 and December 2014. The morbidity and mortality associated with the procedure were determined, together with the postoperative results in terms of effectiveness and recurrence. RESULTS A total of 38 patients were diagnosed with PP within the last 3 years, but only 20 of them had invasive treatment. Laparoscopic surgery was performed on 17 of those patients (mean pseudocyst diameter of 15.3, primary drainage success rate of 94.1%, complication rate of 5.9%, and a 40-month follow-up). CONCLUSIONS The results obtained with the laparoscopic technique used at our hospital center showed that this approach is feasible, efficacious, and safe. Thus, performed by skilled surgeons, it should be considered a treatment option for patients with PP.
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Affiliation(s)
- B A Crisanto-Campos
- Clínica de Cirugía Hepatobiliar y Pancreática del Departamento de Cirugía General, Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México.
| | - E Arce-Liévano
- Departamento de Cirugía Endoscópica, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - L E Cárdenas-Lailson
- Clínica de Cirugía Hepatobiliar y Pancreática del Departamento de Cirugía General, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - L S Romero-Loera
- Departamento de Cirugía General, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - M E Rojano-Rodríguez
- Departamento de Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - M A Gallardo-Ramírez
- Departamento de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - J Cabral-Oliver
- Departamento de Cirugía Bariátrica, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - M Moreno-Portillo
- Departamento de Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
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Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2015. [DOI: 10.1016/j.rgmxen.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Jia CK, Lu XF, Yang QZ, Weng J, Chen YK, Fu Y. Pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction for benign pancreatic diseases. World J Gastroenterol 2014; 20:13200-13204. [PMID: 25278718 PMCID: PMC4177503 DOI: 10.3748/wjg.v20.i36.13200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/09/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Surgery such as digestive tract reconstruction is usually required for pancreatic trauma and severe pancreatitis as well as malignant pancreatic lesions. The most common digestive tract reconstruction techniques (e.g., Child’s type reconstruction) for neoplastic diseases of the pancreatic head often encompass pancreaticojejunostomy, choledochojejunostomy and then gastrojejunostomy with pancreaticoduodenectomy, whereas these techniques may not be applicable in benign pancreatic diseases due to an integrated stomach and duodenum in these patients. In benign pancreatic diseases, the aforementioned reconstruction will not only increase the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the risks of traction, twisting and angularity of the jejunal loop. In addition, postoperative complications such as mixed fistula are refractory and life-threatening after common reconstruction procedures. We here introduce a novel pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction in two cases of benign pancreatic disease, thus decreasing not only the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the possibility of postoperative complications compared to common reconstruction methods. Postoperatively, the recovery of these patients was uneventful and complications such as bile leakage, pancreatic leakage and digestive tract obstruction were not observed during the follow-up period.
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15
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Therapie chronisch persistierender Biliome nach Leberresektion durch enterale Drainage. Chirurg 2014; 86:682-6. [DOI: 10.1007/s00104-014-2836-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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16
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Türkvatan A, Erden A, Türkoğlu MA, Seçil M, Yüce G. Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis. Diagn Interv Imaging 2014; 96:161-9. [PMID: 24703377 DOI: 10.1016/j.diii.2013.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.
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Affiliation(s)
- A Türkvatan
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey.
| | - A Erden
- Department of Radiology, Ankara University School of Medicine, Talatpaşa Street, 06100 Sıhhiye, Ankara, Turkey
| | - M A Türkoğlu
- Department of General Surgery, Akdeniz University School of Medicine, Dumlupınar street, Antalya, Turkey
| | - M Seçil
- Department of Radiology, Dokuz Eylul University School of Medicine, Cumhuriyet street, İzmir, Turkey
| | - G Yüce
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey
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17
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The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. ACTA ACUST UNITED AC 2013; 38:125-36. [PMID: 22584543 DOI: 10.1007/s00261-012-9908-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the myriad of associated complications but also familiarity with the appropriate radiologic nomenclature as defined by the Atlanta symposium in 1992 and, more recently, by the Acute Pancreatitis Classification Working Group in 2008. The accurate description of the radiological findings plays a critical role in the evaluation and management of patients with acute pancreatitis, particularly those with severe disease. There have been increasing efforts to develop uniformity in the use of terminology used to define the radiologic findings in acute pancreatitis, in particular, the terminology for fluid collections, a common area of inconsistency and confusion. Terms such as "acute peripancreatic fluid collections," "acute post- necrotic fluid collections," "pseudocyst," and "walled-off pancreatic necrosis" are now recommended as they describe the evolution of fluid collections in patients with both interstitial and necrotizing pancreatitis and nonspecific terms such as "pancreatic abscess" and "phlegmon" are being abandoned. In this review we illustrate, with case examples, the standardized terminology used in the radiological and clinical description of acute pancreatitis, its severity, and complications with an emphasis on the role of ultrasound, computed tomography and magnetic resonance imaging. Different management options of the associated complications are also discussed. The use of standardized terminology will hopefully improve the communication between radiologists, gastroenterologists, and surgeons to facilitate treatment planning and will lead to enhanced outcomes for patients with acute pancreatitis as well as create uniformity for enrollment into research studies.
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18
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Patel AD, Lytle NW, Sarmiento JM. Laparoscopic Roux-en-Y Drainage of a Pancreatic Pseudocyst. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0013-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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20
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Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 2 (tratamiento). GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:422-36. [DOI: 10.1016/j.gastrohep.2012.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 12/20/2012] [Accepted: 12/27/2012] [Indexed: 02/08/2023]
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21
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Minimally invasive management of pancreatic pseudocysts. Wideochir Inne Tech Maloinwazyjne 2013; 8:211-5. [PMID: 24130634 PMCID: PMC3796721 DOI: 10.5114/wiitm.2011.33809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/18/2013] [Accepted: 02/08/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The laparoscopic and endoscopic approaches to internal drainage of pancreatic pseudocysts (PP) are the current minimally invasive management options. Indications, and early and late results of endoscopic and laparoscopic approaches are being discussed. AIM To present experience in treatment of PP by laparoscopic pseudocystogastrostomy (LPGS) and endoscopic pseudocystogastrostomy (EPGS) and to compare results, feasibility and safety. MATERIAL AND METHODS THIRTY PATIENTS UNDERWENT SURGICAL INTERVENTION: 18 patients - LPGS (group I), 12 - EPGS (group II). Groups were compared by age, gender, pancreatic pseudocysts's age, diameter and localization, as well as intraoperative, early and late postoperative complications. RESULTS GENDER DISTRIBUTION, GROUP I: 14 (77.8%) men and 4 (22.2%) women, group II: 4 (33.3%) men and 8 (66.7%) women, p = 0.02. Average cyst diameter: group I - 149.9 ±52.1 mm, group II - 119 ±37.9 mm, p = 0.07. Average time between diagnosis and operation performance: group I - 12 (3-60) months, group II - 8 (2-36) months, p = 0.19. Neither in group I nor in group II did intraoperative complications occur. Early postoperative complications were divided into minor and major. Early minor complications: group I - 2 (11.1%), group II - 0, p = 0.5. Early major complications: group I - 0, group II - 2 (16.7%), p = 0.15. Late postoperative complications: group I - 0, group II - 1 (8.3%), p = 0.4. In group I there was no case, whereas in II group there was 1 (8.3%) case of recidivation, p = 0.4. CONCLUSIONS For selected patients both minimally invasive methods are equally safe an effective. For comprehensive evaluation of methods prospective trials are needed.
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22
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Patrzyk M, Maier S, Busemann A, Glitsch A, Heidecke CD. [Therapy of pancreatic pseudocysts: endoscopy versus surgery]. Chirurg 2013; 84:117-24. [PMID: 23371027 DOI: 10.1007/s00104-012-2376-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pancreatic pseudocysts are frequent complications following acute and chronic pancreatitis as well as abdominal trauma. They originate from enzymatic and/or necrotizing processes within the organ involving the surrounding tissues through inflammatory processes following pancreatic ductal lesion(s). Pseudocysts require definitive treatment if they become symptomatic, progressive, larger than 5 cm after a period of more than 6 weeks and/or have complications. Cystic neoplasms must be excluded before treatment. Endoscopic interventions are commonly accepted first line approaches. Should these fail or not be feasible surgical procedures have been well established and show comparable results. In summary, pancreatic pseudocysts require a reliable diagnostic approach with a multidisciplinary professional management involving gastroenterologists and surgeons.
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Affiliation(s)
- M Patrzyk
- Abteilung für Allgemeine Chirurgie, Viszeral-, Thorax- und Gefäßchirurgie, Klinik und Poliklinik für Chirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland.
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23
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Hackert T, Schneider L, Büchler M. Chirurgisches Vorgehen bei chronischer Pankreatitis. Chirurg 2013; 84:112-6. [DOI: 10.1007/s00104-012-2375-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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24
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de-Madaria E, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de-Las-Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero EC, Martínez J. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology 2012; 13:18-28. [PMID: 23395565 DOI: 10.1016/j.pan.2012.11.310] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/11/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
Abstract
Chronic pancreatitis (CP) is a complex disease with a wide range of clinical manifestations. This range comprises from asymptomatic patients to patients with disabling symptoms or complications. The management of CP is frequently different between geographic areas and even medical centers. This is due to the paucity of high quality studies and clinical practice guidelines regarding its diagnosis and treatment. The aim of the Spanish Pancreatic Club was to give current evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. These experts were selected according to clinical and research experience in CP. A list of questions was made and two experts reviewed each question. A draft was later produced and discussed with the entire panel of experts in a face-to-face meeting. The level of evidence was based on the ratings given by the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus, recommendations were given regarding the management of pain, pseudocysts, duodenal and biliary stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP.
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Affiliation(s)
- E de-Madaria
- Pancreatic Unit, University General Hospital of Alicante, Spain.
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Abstract
The advent of computed tomographic scan with its wide use in the evaluation of acute pancreatitis has opened up a new topic in pancreatology i.e. fluid collections. Fluid collections in and around the pancreas occur often in acute pancreatitis and were defined by the Atlanta Symposium on Acute Pancreatitis in 1992. Two decades since the Atlanta Conference additional experience has brought to light the inadequacy and poor understanding of the terms used by different specialists involved in the care of patients with acute pancreatitis when interpreting imaging modalities and the need for a uniformly used classification system. The deficiencies of the Atlanta definitions and advances in medicine have led to a proposed revision of the Atlanta classification promulgated by the Acute Pancreatitis Classification Working Group. The newly used terms "acute peripancreatic fluid collections," "pancreatic pseudocyst," "postnecrotic pancreatic/peripancreatic fluid collections," and "walled-off pancreatic necrosis" are to be clearly understood in the interpretation of imaging studies. The current treatment methods for fluid collections are diverse and depend on accurate interpretations of radiologic tests. Management options include conservative treatment, percutaneous catheter drainage, open and laparoscopic surgery, and endoscopic drainage. The choice of treatment depends on a correct diagnosis of the type of fluid collection. In this study we have attempted to clarify the management and clinical features of different types of fluid collections as they have been initially defined under the 1992 Atlanta Classification and revised by the Working Group's proposed categorization.
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Zerem E, Imamović G, Omerović S, Ljuca F, Haracić B. Percutaneous treatment for symptomatic pancreatic pseudocysts: Long-term results in a single center. Eur J Intern Med 2010; 21:393-397. [PMID: 20816592 DOI: 10.1016/j.ejim.2010.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 06/26/2010] [Accepted: 06/29/2010] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of the study was to present and evaluate the long-term results of percutaneous catheter drainage (PCD) in the treatment of symptomatic pancreatic pseudocysts (PPC). METHODS We performed a retrospective analysis of 128 patients with 140 PPC treated by PCD from 01/01/1989 to 12/31/2008. All procedures were performed under ultrasound control. Surgical treatment was planned only in patients with failed PCD. The patients were followed up monthly with sonography for 12 months. The primary outcome was conversion rate to surgery. Secondary outcomes were disappearance of PPC, requirement for additional treatment, length of hospital stay, and catheter dwell time. RESULTS During the follow-up, 42 of the 140 cysts (30%) recurred. 19/42 cysts were small and they were followed up without intervention and 23/42 cysts required further intervention. These patients were offered a second attempt but 5 patients declined it and they chose to undergo surgery. The remaining 18 patients underwent second PCD and 10 of them developed recurrence. All of them underwent third PCD and 6 of the 10 patients developed recurrences. Four and 2 of them necessitated surgery and follow-up, respectively. In total, 9 of the 128 patients (7%) underwent surgery during the study period. Medians (interquartile ranges) of hospital stay and catheter dwell time were 19 (14-23) and 23 (15-43) days, respectively. There were no complications related to the procedure. CONCLUSION PCD is a safe and effective management for PPC, with low recurrence rates and complication rate and it can eliminate the need for surgery in majority of patients with PPC.
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Affiliation(s)
- Enver Zerem
- University Clinical Center Tuzla, Trnovac bb, Tuzla, Bosnia and Herzegovina.
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Ma ZH, Ma QY, Sha HC, Wu SL, Wen J. Magnetic resonance cholangiopancreatography for the detection of pancreatic duct stones in patients with chronic pancreatitis. World J Gastroenterol 2009; 15:2543-6. [PMID: 19469007 PMCID: PMC2686915 DOI: 10.3748/wjg.15.2543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the role of magnetic resonance cholangiopancreatography (MRCP) in detection of pancreatic duct stones (PDS) in patients with chronic pancreatitis (CP).
METHODS: Clinical data of 78 CP patients who were treated at the First Affiliated Hospital of Xi’an Jiaotong University (China) between January 2004 and July 2008 were retrospectively analyzed. A predictive model of pancreatic duct stones was established through logistic regression and its effectiveness was verified. Among these patients, MRCP was performed in 60 patients who served as a control group, while 44 patients with a higher predictive value than the entry threshold of the predictive model served as an experimental group.
RESULTS: The positive rate of PDS in the 78 patients with CP was 19.2% (15/78). The predictive entry threshold of the predictive model was 5% (P < 0.05). The possibility of existence of PDS could be predicted according to the following 4 indexes: gastrointestinal symptoms, intermittent abdominal pain, diabetes mellitus (DM)/impaired glucose tolerance (IGT) and positive B-mode ultrasound results. The incidence of PDS in the experimental group was higher than that in the control group (P < 0.05).
CONCLUSION: MRCP is strongly suggested for the detection of PDS in patients with gastrointestinal symptoms, intermittent abdominal pain, DM/IGT and positive B-mode ultrasound results.
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28
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Complications of Gallstones: The Mirizzi Syndrome, Gallstone Ileus, Gallstone Pancreatitis, Complications of “Lost” Gallstones. Surg Clin North Am 2008; 88:1345-68, x. [PMID: 18992599 DOI: 10.1016/j.suc.2008.07.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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