Curr Health Sci J, vol. 39, no. 3, 2013

Surgical Drainage versus Endoscopic Drainage in Pancreatic Pseudocyst

[Original Paper]

S. SANDULESCU1,2, V. SURLIN1,2, D. MARGARITESCU1,2, E. GEORGESCU1,2, I. GEORGESCU1,2

1University of Medicine and Pharmacy of Craiova, Department of Surgery; 2Emergency Clinical Hospital of Craiova, Romania, Surgery Clinic No.1


Abstract:

Pancreatic pseudocyst (PP) is an intra or peripancreatic fluid collection, without an epithelial coating, containing pancreatic juice rich in proteolytic enzymes, without clinical signs of infection. It is one of the most frequent complications of acute and chronic pancreatitis, patients with these disorders often benefit from interventional therapy, surgical or minimally invasive. We compared results obtained by open surgery with endoscopic treatment in 20 patients with pancreatic pseudocyst, admitted in Craiova Surgery I Clinic in the period 2006-2011. In 13 patients (65%) the endoscopic drainage was attempted and was successful in 10 (76.7% efficiency). Failure was due to puncture site bleeding, thick wall of PP or abundant collateral circulation. Endoscopic drainage consisted in transgastric drainage (5 cases), transduodenal in (3 patients) and transpapillary by ERCP (2 patients). Conventional surgery was required in 8 patients (40%), 7 of them as elective surgery and one in emergency due heavy bleeding after endoscopic internal drainage attempt. We practiced 4 pseudocyst-gastrostomy, 3 pseudocyst-jejunostomy and 3 external drainage (2 patients with dual localization of PP). There was a severe postoperative complication - upper gastrointestinal bleeding from the splenic artery which required reintervention. Results were positive by both therapeutic approaches, with differences in the number of days of hospitalization, patient comfort and post interventional evolution in favour of endoscopic approaches.


Keywords:
pancreatic pseudocyst, surgical drainage, endoscopic drainage



Corresponding:
Sandulescu Sarmis, M.D., Surgery Clinic No.1, Emergency Clinical Hospital Craiova,. No. 1, Tabaci Str., Craiova, Romania; e-mail: ssarmis@yahoo.com


DOI 10.12865/CHSJ.39.03.07 - Download PDF