Infected Pancreatic Pseudocysts: Surgical Treatment

Abstract

Introduction. The incidence of pancreatic pseudocysts (PPC) amounts to 0.5–1 per 100,000 adults per year. In all the pancreatic disorders the incidence of PPC amounts to 1.6-4.5%. Designing an individually tailored treatment programme using minimally invasive techniques to ensure the longest lasting treatment effect combined with the reduction of surgical trauma is an important issue of today’s surgery.Materials and methods. This paper presents a retrospective analysis of surgeries performed on 101 patients with infected PPC treated in the period from 2000 to 2015 at surgical wards of the Centre for Emergency and Disaster Medicine of the Regional Teaching Hospital, Kharkiv, Ukraine and the Department of Pancreatic and Bile Duct Surgery of A. A. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine. Of these, 74 patients (73.3%) were male and 27 (26.7%) — female, aged 21 to 79, average age of patients was 43.3±1.2 years.Results. Percutaneous drainage was administered to patients with type I infected PPC with the onset of multiple organ failure in order to make the wait-and-see strategy possible and to alleviate the patient’s general condition and improve the course of sepsis. For patients with type II and III infected PPC percutaneous punctures were the final stage of treatment in 80% of cases. Whether radical surgical procedures were performed depended on the severity of the patient’s condition, degree of pancreatic necrosis or chronic pancreatitis spread, PC localisation, duct system condition and complications involving neighbouring organs.Conclusion. When treating patients with PPC one has to use an individually tailored treatment strategy based on state of the art minimally invasive treatment techniques. When treating infected PPC both minimally invasive and traditional open access procedures have to be considered as mutually complementing, presenting a broad range of diagnostic and treatment options.