Experience with laparoscopic procedures in children with pancreatic pseudocysts

Abstract

Introduction. Pancreatic pseudocysts are encapsulated fluid accumulations in the lesser sac, devoid of epithelial lining. Pseudocysts occur after traumatic or inflammatory injury of the pancreatic parenchyma and are relatively rare in children. In recent years, there has been a trend towards minimally invasive surgery for pancreatic pseudocyst. The article presents the experience of laparoscopic operations. Purpose to the study is to evaluate the effectiveness of laparoscopic operations in children with pancreatic pseudocysts. Materials and methods. There were 11 patients, range 4–17 years, from 2013 to 2018. An indication for surgery was the presence of a cystic cavity with a formed wall, more than 6 cm in size, which was not amenable to conservative management. In cases of infection of unformed pseudocyst, we conducted external drainage through the anterior abdominal wall and the gastrocolic ligament. Results. Surgical therapies for 11 patients consisted external drainage (2), laparoscopic Roux-en-Y cystojejunostomy (6), laparoscopic partial cystectomy with distal pancreaticojejunostomy (1), laparoscopic partial cystectomy with longitudinal pancreaticojejunostomy (2). We don’t have intraoperative complications. Early postoperative complications occurred in 2 patients: external pancreatic fistula in the place of drainage, which closed independently, and intestinal obstruction at the level of the Roux-en-Y anastomosis, which required reconstructive surgery. Conclusion . The type of intervention should be determined by the etiology of the cyst, localization and connection with the main pancreatic duct. Laparoscopic surgery in children with pancreatic pseudocysts is effective and less traumatic. Laparoscopy allows to conduct a full revision, to take material for histological examination, to perform, if necessary, sequestrectomy, to ensure reliable long-term drainage.