Surgical Treatment of Pancreatic Pseudocysts - Indications and Choice Between a Drainage Procedure and Pancreatic Resection

Abstract

Introduction: Pancreatic pseudocysts mostly occur as a consequence of acute pancreatitis. However, they can also occur in the setting of chronic pancreatitis, postoperatively, or after a pancreatic trauma. Pseudocysts may be asymptomatic or may present with a variety of symptoms such as pain, satiety, nausea and vomiting, upper gastrointestinal bleeding, etc. In 33% of the cases, pancreatic pseudocysts disappear spontaneously. Most of the persistent pseudocysts require treatment because of the occurrence of symptoms, increase in size, and the impossibility for the differentiation of the malignant process or due to the development of complications (bleeding, hemorrhage, rupture or compression of the stomach, duodenum or bile ducts). Aim: The aim of this paper is to investigate the experience of the Clinic in the treatment of pancreatic pseudocysts and to determine, on this basis, the indications for surgery and the factors influencing the choice of a specific surgical strategy. Materials and Methods: In KOCHPH, University Hospital `Alexandrovska`, a retrospective study was carried out. It covered the period 1999 - 2015 and included 213 patients who underwent surgery for pancreatic pseudocysts. Clinicopathological material (size, number and arrangement of pseudocysts, type and duration of the symptoms, data from the imaging tests and type of applied treatment) was analyzed by various statistical methods using SPSS-19. Results: 36 pancreatocystogastrostomies, 28 pancreatocystojejunostomies, 21 pancreatocystoduodenostomies, and 3 pancreatowirsungojejunostomies were performed. External drainage was carried out in 33 patients. The applied resections were: 44 distal pancreatic resections, 6 pancreatoduodenectomies, 9 cystic extirpations, and 8 cystoresections. In some cases, combined surgical procedures were performed. Conclusions: Surgery remains the primary method of choice in the treatment of pancreatic pseudocysts with a high success rate - in 91-100% of cases. The choice of a particular surgical strategy depends on the location, number and size of the pseudocysts, presence and type of complications, and the stated changes in the area of the pancreas, as well as the relations with the surrounding tissues and organs. Therefore, the precise diagnostic process and individualized approach to treatment are the basis for achieving optimal and lasting postoperative results.