CHSJ

Curr Health Sci J, vol. 39, no. 4, 2013

Current Therapeutic Modalities of Pancreatic Pseudocyst

[For Practitioner]

V. SURLIN(1), E. GEORGESCU(1), M. GEORGESCU(1), D. MARGARITESCU(1), D. CARTU(1), L. CHIUTU(2), S. SANDULESCU(1), S. RAMBOIU(1), F. CIOARA(1), A. SAFTOIU(3), I. GEORGESCU(1)


(1)1st Surgery Clinic, University of Medicine and Pharmacy of Craiova;
(2)Clinic for Anesthesiology and Intensive Care;
(3)Gastroenterology Department, University of Medicine and Pharmacy of Craiova


Abstract:

Pancreatic pseudocyst (PP) is a peripancreatic fluid collection with definite wall, without epitelial lining, occuring lately in the course of severe acute pancreatitis. It is due to the extravasation of pancreatic secretions form disrupted pancreatic ducts. 80% communicate with the pancreatic ducts. Natural course is dominated by resorbtion in more than 50%. The rest, may persist, enlarge and become symptomatic and/or generating complications. Asymptomatic PP more than 6 cm in diameter and persisting more than 6 weeks are considered fot therapy because of fear for complications. Open surgery was the mainstay of therapeutic approach until recently, with good short and long term results. The minimally-invasive approach is actually in full development challenging the place of open surgery. The main objective is the drainage (extern or intern) and very rarely the resection. The external drainage is indicated in PP with thin walls of infected. Percutaneous drainage avoids pancreatic fistula, prolonged hospitalization or infection risk. Endoscopic approach for internal drainage may be the economically better, simpler and safer especially when guided ultrasonographically. Laparoscopic surgery is at the beginning but promising. However, it is expensive and lasts long. Surgical excision is very rarely indicated. In conclusion, PP with indication for therapy, with little exception, should be evaluated for internal endoscopic drainage. Under ultrasonographic guidance it proved feasable, safe and efficient. Open surgery would remain for failures, complications and exclusions from endoscopic approach and the percutaneous approach guided by imagery, for the critical patient with infected PP.


Keywords: pancreatic pseudocyst, pancreas, external drainage, internal drainage



Corresponding: Valeriu Surlin, MD,PhD, Surgery Clinic no.1, Emergency County Hospital of Craiova, Tabaci St. no.1, Craiova, Dolj, e-mail: vsurlin@gmail.com


DOI 10.12865/CHSJ.39.04.11 - Download PDF
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