A Retrospective Study on Comparison Between Surgical and Endoscopic Management of Pancreatic Pseudocyst and Walled-off Pancreatic Necrosis

Abstract

BACKGROUND: Surgical management is the standard approach for pancreatic pseudocyst and walled off pancreatic necrosis. With newly evolving procedures and a comprehensive approach, management of walled off pancreatic necrosis and pancreatic pseudocyst is taking a new turn. A multi-centric study comparing surgical and endoscopic management of pancreatic pseudocyst and walled off pancreatic necrosis was performed. METHODS: Data was collected retrospectively from multiple centers and patients were followed up till date since the time of intervention. The outcomes were therapeutic success, post-operative complications, recurrence rate, mortality and duration of hospitalization. RESULTS: At the end of the follow-up period, none of the patients who received endoscopic intervention had a recurrence, compared to 2 patients in the surgical group. There was 16.67% mortality in the surgical group and only 3.33% mortality in the endoscopic group. Significantly high mortality was seen in the patients with Walled-Off Pancreatic Necrosis treated surgically, compared to no mortality in the patients treated endoscopically. 86 % of the patients in the endoscopic group had resolution of the disease following intervention compared to 70% in the other group. There were no statistically significant differences in mortality, resolution or recurrence of disease following intervention between the two groups. However, the length of hospital stay was significantly shorter for patients who underwent endoscopic intervention than open surgery. CONCLUSION: Endoscopic drainage of Pancreatic Pseudocysts and Walled off Pancreatic necrosis have demonstrated a therapeutic success rate, mortality and recurrence statistically comparable to that seen in surgical treatment, but with reduced time of hospitalization, supporting its use as the preferred initial modality for drainage.