Internal Drainage Of Pancreatic Pseudocysts Research Articles

Internal drainage of pancreatic pseudocyst following abdominal blunt trauma

Pancreatic pseudocyst is a well-recognized complication of acute pancreatitis, chronic pancreatitis and pancreatic trauma. Pancreatic trauma is the most common cause among children cases. The aim of this study is to describe the clinical presentation and management of symptomatic pancreatic pseudocyst in a series of 2 children following abdominal blunt trauma treated in our institution between January 2021 to August 2021. This was single-centre case series from our institution that is a tertiary referral hospital from January to August 2021. There were two patients between age 8–11 that diagnosed with pancreatic pseudocyst after blunt abdominal trauma, both of them underwent open internal drainage, specifically cystojejunostomy. All of 2 patients had a history of blunt abdominal trauma due to bicycle handlebar injury. Epigastric pain and abdominal mass were the main complaints. Amylase and lipase serum level were elevated and imaging diagnostic reveal pancreatic pseudocyst. Open cystojejunostomy were performed and the patient discharged from the hospital on day 7 and day 11 post operative, respectively, without any complication. Pancreatic pseudocyst although rare in children, can lead to a significant morbidity if not properly diagnosed and treated. Open internal drainage is still the procedure of choice in our institution.

Clinical study on cystogastrostomy and Roux-en-Y-type cystojejunostomy in the treatment of pancreatic pseudocyst: A single-center experience.

The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis’ occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.

Laparoscopic loop cystojejunostomy: An alternative to Roux-en-Y cystojejunostomy for pancreatic pseudocyst.

Surgical internal drainage of pancreatic pseudocyst can be done into the stomach, duodenum or jejunum depending on the anatomic relation of pseudocyst with hollow viscera. For cystojejunostomy, a Roux-en-Y loop is preferred over loop cystojejunostomy as former is thought to avoid the reflux of jejunal contents into the cyst cavity. This study presents our experience with laparoscopic loop cystojejunostomy showing loop cystojejunostomy for the pseudocyst of the pancreas can be safely performed laparoscopically with simpler technique with no complications including reflux.

Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion

BackgroundEndoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery.ObjectiveThis study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent.Materials and methodsWe conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening.ResultsImage-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8–47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7–15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children.ConclusionPancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.

The results of endosonography-assisted internal drainage of pancreatic pseudocyst

Aim.To compare immediate and long-term results of internal drainage of pancreatic pseudocyst by using of endosonography-assisted and open surgical approaches.Material and methods.EUS-assisted internal drainage of pancreatic pseudocyst was performed in 32 patients in 2011–2016. Open drainage procedures were carried out on the other 32 patients.Results.In the group of endoscopic drainage, technical success rate, clinical success rate and complication rate were 97%, 85% and 26%, respectively. There were no recurrent pseudocysts in long-term period. Comparison with open surgery confirmed advantages of endoscopic technique regarding time of operation (p&lt; 0.01), intraoperative blood loss (p&lt; 0.01) and length of hospital-stay (p&lt; 0.01).Conclusion.EUS-assisted internal drainage of pancreatic pseudocysts in the treatment of chronic pancreatitis is characterized by high rate of technical and clinical success, small postoperative morbidity and low incidence of longterm recurrences.

Endoscopic methods of internal drainage of pancreatic pseudocysts.

Background: A steady increase in the incidence of chronic pancreatitis and its complications has been registered over the decade. Application of EUS-guided drainage has improved the results of treatment of this group of patients. Methods: In the period from 2007 to December 2016, 263 patients were treated for chronic pancreatitis at Botkin Clinical hospital, 211 of which were operated in the HPB department of the hospital. All the patients underwent ultrasound examination, CT with oral and intravenous contrasting, MRCP, tumor marker analysis. In questionable tumor cases an EUS examination was conducted with fine needle biopsy. The patients’ age averaged 51 (20 to 70 years old), with 211 male (80.2%) and 52 female patients (19.8%). Internal EUS-guided drainage of pseudocysts was performed in 28 cases. The average size of the cysts was 55 ± 65 mm. In 18 cases (8.5%) a nitinol stenting was performed, in 10 cases (4.7%) – a double-pigtail stenting was performed. Stents were removed 4-6 weeks after the introduction depending on the control CT results. Results: The clinical effect was obtained in 100% of the cases. Complications were diagnosed in 2 patients who had plastic stents (cyst recurrence, abscess) and in one patient with a nitinol stent (stent dislocation). No cases of mortality were registered. Conclusion: The employment of EUS-guided drainage of the pancreatic pseudocysts can improve treatment results and helps avoid major surgical procedures in such cases.

Endoscopic methods of internal drainage of pancreatic pseudocysts.

Background: A steady increase in the incidence of chronic pancreatitis and its complications has been registered over the decade. Application of EUS-guided drainage has improved the results of treatment of this group of patients. Methods: In the period from 2007 to December 2016, 263 patients were treated for chronic pancreatitis at Botkin Clinical hospital, 211 of which were operated in the HPB department of the hospital. All the patients underwent ultrasound examination, CT with oral and intravenous contrasting, MRCP, tumor marker analysis. In questionable tumor cases an EUS examination was conducted with fine needle biopsy. The patients’ age averaged 51 (20 to 70 years old), with 211 male (80.2%) and 52 female patients (19.8%). Internal EUS-guided drainage of pseudocysts was performed in 28 cases. The average size of the cysts was 55 ± 65 mm. In 18 cases (8.5%) a nitinol stenting was performed, in 10 cases (4.7%) – a double-pigtail stenting was performed. Stents were removed 4-6 weeks after the introduction depending on the control CT results. Results: The clinical effect was obtained in 100% of the cases. Complications were diagnosed in 2 patients who had plastic stents (cyst recurrence, abscess) and in one patient with a nitinol stent (stent dislocation). No cases of mortality were registered. Conclusion: The employment of EUS-guided drainage of the pancreatic pseudocysts can improve treatment results and helps avoid major surgical procedures in such cases.

Pancreatic Pseudocyst Dilemma: Cumulative Multicenter Experience in Management Using Endoscopy, Laparoscopy, and Open Surgery.

Pancreatic pseudocyst (PP) is the commonest cystic lesion of the pancreas. Internal drainage of PPs can be accomplished by traditional open or recently by minimally invasive laparoscopic or endoscopic approaches. We aimed to evaluate and compare the clinical outcomes after endoscopic, laparoscopic, and open drainage. Seventy-one patients with PP underwent endoscopic (n = 35), laparoscopic (n = 4), and open surgical drainage (n = 32). The primary outcome was the success rate. The secondary outcomes were the estimated blood loss, operative time, opioid requirement, morbidity and mortality, length of hospital stay, and recurrence rate. The primary success rate was significantly higher for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups. There were no significant differences in the morbidity, mortality, requirement of blood transfusion, reinterventions, and recurrence rate between the groups. Endoscopic drainage revealed significantly lower blood loss, operative time, opioid requirement, and hospital stay in comparison to open and laparoscopic drainage. Minimally invasive therapeutic techniques, whether endoscopic or laparoscopic for treatment of PP could be considered valuable, competitive, and promising alternatives for open surgery. Moreover, it is less invasive with less hospitalization and rapid return to work.

Changing pattern of laparoscopic internal drainage of pancreatic pseudocyst in the era of endoscopy: Experience from a tertiary centre in South India

Background: Management of symptomatic pancreatic pseudocyst (PPC) underwent major changes from open to laparoscopic and then to endoscopic internal drainage. PPC which are amenable for cystogastrostomy are being managed in increasing numbers by endoscopic methods and those in other locations are still managed by surgical methods mainly by jejunal drainage. Methods: Patients who underwent laparoscopic internal drainage for PPC at our centre from May 2007 until August 2015 were analysed from a prospectively maintained data base. Results: There were 56 patients (50 males and 6 females), average age of 41 years and associated co-morbidity in 28.5%. Alcohol pancreatitis was seen in 20 cases (35.7%), biliary pancreatitis in 16 cases (28.5%), 1 case each of auto immune pancreatitis, traumatic and post ERCP induced pancreatitis. Laparoscopic cystogastrostomy (LCG) was done in 42 cases (75%), laparoscopic cystojejunostomy (LCJ) in 14 cases (25%).The mean operating time was 140 minutes. Mean hospital stay was 6.5 days. Two patients in LCG were re-operated for stomal bleeding and leak from gastrostomy wound. We had no mortality and nil recurrence. During this period, we had 14 cases of PPC done by Endoscopic CG which were excluded from this study. In our previous series, between 1994–2006, of the total 108 cases, LCG was done in 90 cases (83.4%) and LCJ was done in 8 cases (7.4%). Conclusion: Our experience in two different time period shows that there is increasing proportion of LCJ being done compared to LCG due to growing role of endoscopy in management of PPC.

Methods of internal drainage of pancreatic pseudocysts

To present own experience of internal drainage and characteristics of its different variants which are applied in various countries. Endosonography-assisted internal drainage of pancreatic pseudocysts was performed in 25 patients. Plastic stents were implanted in one stage without change of instruments while metal stents - with change of instruments during manipulation. Intervention was successful in 24 patients. In 1 case bleeding developed during cystostomy that required open surgery. Plastic and metal stents were used in 11 and 12 patients respectively. 1 patient had two pancreatic pseudocysts. Therefore 2 stents of both types were used in this case. Clinical success was achieved in 91% of cases. Different variants of method resolve problem of surgical approach, stomy and choice of stent. However every technique is targeted to resolve separate problem while single method is not accepted. Further large comparative studies are necessary to define optimal technique of internal drainage.

Surgical management of complicated pancreatic pseudocysts after acute pancreatitis

BackgroundManagement of pancreatic pseudocysts (PP) is unclear when located in areas outside the lesser sac, infected, or when portal venous (PV) occlusion is present. MethodsPatients having internal drainage of PP. Management and outcome were assessed relative to location, presence of infection, and/or PV occlusion. ResultsNo patient required transfusion, and there were no readmissions in 9 patients with PV occlusion. Eleven patients had infected PP including 5 extending outside the lesser sac. Six had postoperative imaging, 4 readmission, and 3 required adjunct postoperative percutaneous drainage. All but 2 with PP beyond the lesser sac had Roux-en-Y cystjejunostomy including 4 with 2 anastomoses. Nine, 4, and 5 required reimaging, readmission, and postoperative therapeutic intervention, respectively. Conclusions(1) Open PP drainage in the face of PV occlusion confers a low risk of bleeding and a minimal need for reimaging or readmission; (2) internal drainage of infected PP is a viable option to external drainage; and (3) PP extending beyond the lesser sac can most often be managed successfully by Roux-en-Y drainage but may require additional intervention.

Internal drainage of pancreatic pseudocysts

Internal drainage of pancreatic pseudocysts

Laparoscopic transgastric endolumenal cystogastrostomy and pancreatic debridement

Cystogastrostomy is commonly performed for internal drainage of pancreatic pseudocysts (PP) and concomitant debridement of walled-off pancreatic necrosis (WOPN). While an open approach to cystogastrostomy is well established, an optimal minimally invasive technique continues to evolve. This laparoscopic transgastric endolumenal cystogastrostomy presented here allows for a large cystogastrostomy with complete debridement of necrosis and internal drainage through a minimally invasive approach. We performed a retrospective review of 22 patients with symptomatic PP/WOPN treated with attempted laparoscopic transgastric endolumenal cystogastrostomy (Lap-TEC) and pancreatic debridement. Short- and long-term outcomes were assessed. From November 2006 to March 2013, a total of 22 Lap-TEC/pancreatic debridement procedures were attempted; 15 were completed laparoscopically. The median age of the cohort was 49.5 ± 12 years (range = 18-71), average body mass index = 29.1 kg/m(2), 77 % had an ASA score ≥ 3, and 10 were female. Gallstones were the most common etiology (50 %), and median time between initial presentation and surgery was 86 days (range = 0-360). Median operative time and estimated blood loss were 213 min and 100 cc, respectively. Forty-one percent of the patients were admitted to the ICU postoperatively and the average length of stay was 14 days (range = 4-50). Median follow-up was 2 months (range = 0-62.5), with one patient having a procedure-related complication. No other reoperations, late complications, or mortalities occurred. All patients had resolution of their symptoms and fluid collections. This technique of internal drainage via Lap-TEC and pancreatic debridement has been successful in achieving primary drainage and relieving symptoms of PP/WOPN with no mortality and minimal morbidity.

Minimally invasive management of pancreatic pseudocysts.

IntroductionThe laparoscopic and endoscopic approaches to internal drainage of pancreatic pseudocysts (PP) are the current minimally invasive management options. Indications, and early and late results of endoscopic and laparoscopic approaches are being discussed.AimTo present experience in treatment of PP by laparoscopic pseudocystogastrostomy (LPGS) and endoscopic pseudocystogastrostomy (EPGS) and to compare results, feasibility and safety.Material and methodsThirty patients underwent surgical intervention: 18 patients – LPGS (group I), 12 – EPGS (group II). Groups were compared by age, gender, pancreatic pseudocysts’s age, diameter and localization, as well as intraoperative, early and late postoperative complications.ResultsGender distribution, group I: 14 (77.8%) men and 4 (22.2%) women, group II: 4 (33.3%) men and 8 (66.7%) women, p = 0.02. Average cyst diameter: group I – 149.9 ±52.1 mm, group II – 119 ±37.9 mm, p = 0.07. Average time between diagnosis and operation performance: group I – 12 (3-60) months, group II – 8 (2-36) months, p = 0.19. Neither in group I nor in group II did intraoperative complications occur. Early postoperative complications were divided into minor and major. Early minor complications: group I – 2 (11.1%), group II – 0, p = 0.5. Early major complications: group I – 0, group II – 2 (16.7%), p = 0.15. Late postoperative complications: group I – 0, group II – 1 (8.3%), p = 0.4. In group I there was no case, whereas in II group there was 1 (8.3%) case of recidivation, p = 0.4.ConclusionsFor selected patients both minimally invasive methods are equally safe an effective. For comprehensive evaluation of methods prospective trials are needed.

New devices and techniques for management of pancreatic fluid collections

New devices and techniques for management of pancreatic fluid collections

Endoscopic Ultrasound-Guided Transmural Internal Drainage of Pancreatic Pseudocyst and Pancreatic Abscess

Endoscopic Ultrasound-Guided Transmural Internal Drainage of Pancreatic Pseudocyst and Pancreatic Abscess

Mo1395 First Clinical Experience Using the AXIOS Stent and Delivery System for Internal Drainage of Pancreatic Pseudocysts and the Gallbladder

Mo1395 First Clinical Experience Using the AXIOS Stent and Delivery System for Internal Drainage of Pancreatic Pseudocysts and the Gallbladder

Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts

Internal drainage of pancreatic pseudocysts can be accomplished by traditional open or minimally invasive laparoscopic or endoscopic approaches. This study aimed to evaluate the primary and overall success rates and clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Records of 83 patients undergoing laparoscopic (n = 16), endoscopic (n = 45), and open (n = 22) pancreatic cystgastrostomy were analyzed on an intention-to-treat basis. There were no significant differences (p < 0.05) in the mean patient age (years), gender, body mass index (BMI) (kg/m(2)), etiology of pancreatitis (% gallstone), or size (cm) of pancreatic pseudocyst between the groups. Grade 2 or greater complications occurred within 30 days of the primary procedure for 31.5% of the laparoscopic patients, 15.6% of the endoscopic patients, and 22.7% of the open patients (nonsignificant differences). The follow-up evaluation for 75 patients (90.4%) was performed at a mean interval of 9.5 months (range, 1-40 months). The primary compared with the overall success rate, defined as cyst resolution, was 51.1% vs. 84.6% for the endoscopic group, 87.5% vs. 93.8% for the laparoscopic group, and 81.2% vs. 90.9% for the open group. The primary success rate was significantly higher (p < 0.01) for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups (nonsignificant differences). Primary endoscopic failures were salvaged by open pancreatic cystgastrostomy (n = 13), percutaneous drainage (n = 3), and repeat endoscopic drainage (n = 6). Laparoscopic and open pancreatic cystgastrostomy both have a higher primary success rate than endoscopic internal drainage, although repeat endoscopic cystgastrostomy provides overall success for selected patients.

Laparoscopic and endoscopic approaches for drainage of pancreatic pseudocysts: a systematic review of published series

The laparoscopic and endoscopic approaches to internal drainage of pancreatic pseudocysts (PPs) are the current minimally invasive management options. This article reviews the evidence available on their effectiveness. A computerized search was made of the MEDLINE, PubMed, and EMBASE databases for English language publications from 1974 to 2005. A total of 118 and 569 patients featured, respectively, in 19 and 25 reports underwent 118 and 583 laparoscopic and endoscopic drainage procedures, respectively. Pancreatic pseudocysts were considerably larger in the laparoscopic series (mean, 13 vs. 7 cm; p < 0.0001). The success rates for achieving resolution of the PPs in the laparoscopic and endoscopic series were 98.3% and 80.8% respectively, with morbidity rates of 4.2% and 12% and mortality rates of 0% and 0.4%, respectively. During follow-up period (mean, 13 vs 24 months; p < 0.0001), PPs recurred for 2.5% of the patients in the laparoscopic series and 14.4% of the patients in the endoscopic series, and the reintervention rates were 0.9% and 11.8%, respectively. The laparoscopic and endoscopic approaches to internal drainage of PPs are safe. Although laparoscopic drainage appears to carry a higher success rate and lower rates of morbidity and recurrence, the heterogeneity of the published reports and the varied follow-up periods limit direct comparisons. Data from longer follow-up periods and randomized comparative trials are needed.

Minilaparoscopic transgastric cystgastrostomy

Background A technique combining upper endoscopy with percutaneous transgastric minilaparoscopic instrumentation for the formation of pancreatic cystgastrostomy is safe and effective for the internal drainage of pancreatic pseudocysts. Methods At a tertiary-care academic medical center, 6 patients with pancreatic pseudocysts with a mean size of 19 cm (range, 16–23 cm) were selected for combined endoscopic and percutaneous transgastric minilaparoscopic (1.7–2 mm) pancreatic cystgastrostomy. All pseudocysts had been followed-up for a minimum of 5 weeks (range, 5–22 wk) and were noted to significantly displace the stomach anteriorly. Results The mean surgical time was 98 minutes (range, 45–150 min). The mean amount of fluid removed from the pseudocysts was 2167 mL (range, 1600–2600 mL). All ports were removed from the stomach without the need to suture the gastric wall or skin except for 2 gastric serosal sites that were closed with a single intracorporeal stitch. The length of hospital stay averaged 2.2 days (range, 0–6 d). All patients were discharged in good condition, tolerating a regular diet. With a mean follow-up period of 13.4 months (range, 1–30 mo), all patients remain asymptomatic from their pancreatic pseudocysts. Conclusions The technique of combining upper endoscopy with percutaneous transgastric minilaparoscopic instruments to create a pancreatic cystgastrostomy can be used to apply well-established surgical principals for internal drainage and has the potential to be used for the management of other gastric pathology.