Modern Approaches to the Treatment of Chronic Pancreatitis Complicated by Pancreatic Pseudocysts
https://doi.org/10.16931/1995-5464.2017431-38
Abstract
Aim. Retrospective analysis of conventional and endoscopic surgical treatment of patients with chronic pancreatitis complicated by pancreatic pseudocysts.
Material and Methods. For the period from 2011 to May 2017 two hundred and eighty-two patients were treated for chronic pancreatitis. In 91 (32.3%) patients disease was complicated by post-necrotic pancreatic cysts. 38 patients underwent conventional or laparoscopic surgical treatment. Minimally invasive surgical treatment including endosonography-assisted cystogastro-/ cystoduodenostomy was offered to 38 patients. 15 patients with symptomless pancreatic pseudocysts ≤ 5 cm are under follow-up.
Results. Mean hospital-stay was 11.2 and 6.4 days after cystojejunostomy and endoscopic drainage respectively.
Postoperative morbidity was 10.5% (n = 4) per each group. There were more severe complications after conventional procedures: Clavien–Dindo grade II in 1 patient, grade IIIb in 3 patients. At the same time endoscopic surgeries were followed by complications grade II in 3 patients and grade IIIb in 1 patient. Mean life quality score was 70.2 and 74.3 after traditional and endoscopic interventions respectively. Postoperative follow-up was 3 years for all patients.
Conclusion. Internal endosonography-assisted endoscopic drainage of pancreatic pseudocysts may be preferable in patients with chronic pancreatitis.
About the Authors
A. V. Shabunin
Botkin City Clinical Hospital;
Russian Medical Academy of Postgraduate Education, Healthcare Ministry of the Russian Federation
Russian Federation
Russian Federation
Shabunin Alexey Vasilyevich – Doct. of Med. Sci., Professor, Corresponding-member of RAS, Head of the Chair of Surgery of Russian Medical Academy of Postgraduate Education; Chief Physician of Botkin State Clinical Hospital.
2nd Botkinsky drive, 5, Moscow, 125284, Russian Federation;
2/1, Barrikadnaya str., Moscow, 125993, Russian Federation
V. V. Bеdin
Botkin City Clinical Hospital;
Russian Medical Academy of Postgraduate Education, Healthcare Ministry of the Russian Federation
Russian Federation
Russian Federation
Bedin Vladimir Vladimirovich – Cand. of Med. Sci., Deputy Chief Physician for Surgery of Botkin State Clinical Hospital, Associate Professor of the Chair of Surgery of Russian Medical Academy of Postgraduate Education.
2nd Botkinsky drive, 5, Moscow, 125284, Russian Federation;
2/1, Barrikadnaya str., Moscow, 125993, Russian Federation
I. Yu. Korzheva
Botkin City Clinical Hospital;
Russian Medical Academy of Postgraduate Education, Healthcare Ministry of the Russian Federation
Russian Federation
Russian Federation
Korzheva Irina Yuryevna – Doct. of Med. Sci., Professor of the Department of Endoscopy of Russian Medical Academy of Postgraduate Education, Head of Endoscopy Department of the Botkin State Clinical Hospital.
2nd Botkinsky drive, 5, Moscow, 125284, Russian Federation;
2/1, Barrikadnaya str., Moscow, 125993, Russian Federation
D. Yu. Komissarov
Botkin City Clinical Hospital;
Russian Federation
Russian Federation
Komissarov Dmitry Yurievich – Endoscopist at the Botkin State Clinical Hospital.
2nd Botkinsky drive, 5, Moscow, 125284, Russian Federation
V. Yu. Vengerov
Botkin City Clinical Hospital;
Russian Medical Academy of Postgraduate Education, Healthcare Ministry of the Russian Federation
Russian Federation
Russian Federation
Vengerov Veniamin Yurievich – Postgraduate Student of the Chair of Surgery of Russian Medical Academy of Postgraduate Education, Surgeon at the Liver and Pancreatic Surgery Department, Botkin State Clinical Hospital.
2nd Botkinsky drive, 5, Moscow, 125284, Russian Federation;
2/1, Barrikadnaya str., Moscow, 125993, Russian Federation
References
1. Butorova L.I., Vasiliyev A.P., Kozlov I.M., Kuzmichev S.B., Popova T.N., Eletskaya A.O., Egorycheva M.P., Rassypnova L.I. Chronic pancreatitis: features of clinical manifestation and comparative evaluation of the effectiveness of dose-dependent therapy with polyenzymatic drugs and prevention of recurrence of the disease. Russkij medicinskij zhurnal. 2008; 16 (7): 513–522. (In Russian)
2. Danilov M.V., Fedorov V.D. Khirurgija podzheludochnoj zhelezy [Pancreatic surgery]. Moscow: Medicine, 1995. 510 c. (In Russian)
3. Spanier B.W., Dijkgraaf M.G., Bruno M.J. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: An update. Best Pract. Res. Clin. Gastroenterol. 2008; 22 (1): 45–63.
4. Gurusamy K.S., Pallari E., Hawkins N., Pereira S.P., Davidson B.R. Management strategies for pancreatic pseudocysts. Cochrane Database Syst. Rev. 2016; 4: CD011392. DOI: 10.1002/14651858.CD011392.pub2.
5. Lankisch P.G., Weber-Dany B., Maisonneuve P., Lowenfels A.B. Pancreatic pseudocysts: prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis. Pancreatology. 2012; 12 (2): 85–90.
6. Zerem E., Hauser G., Loga-Zec S., Kunosić S., Jovanović P., Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World J. Gastroenterol. 2015; 21 (22): 6850–6860. DOI: 10.3748/wjg.v21.i22.6850.
7. Tyberg A., Karia K., Gabr M., Desai A., Doshi R., Gaidhane M., Sharaiha R.Z. Kahaleh M. Management of pancreatic fluid collections: A comprehensive review of the literature. World J. Gastroenterol. 2016; 22 (7): 2256–2268. DOI: 10.3748/wjg.v22.i7.2256.
8. Hoffmeister A., Mayerle J., Beglinger C., Buchler M.W., Bufler P., Dathe K. English language version of the S3-consensus guidelines on chronic pancreatitis: definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z. Gastroenterol. 2015; 53 (12): 1447–1495. DOI: 10.1055/s-0041-107379.
9. Talukdar R., Reddy D.N. Pancreatic endotherapy for chronic pancreatitis. Gastrointestinal Endosc. Clin. 2015; 25 (4): 765–777. DOI: 10.1016/j.giec.2015.06.010.
10. Gerin O., Prevot F., Dhahri A., Hakim S., Delcenserie R., Rebibo L., Regimbeau J.M. Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis (with video). Surg. Endosc. 2016; 30 (3): 1235–1241. DOI: 10.1007/s00464-015-4331-6.
11. Gloor B., Friess H., Uhl W., Büchler M.W. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig. Surg. 2001; 18 (1): 21–25.
12. Beger H., Siech M. Chronic pabncreatitic. Current surgical therapy. A Harcourt Heals Sciens Company. 2001. Р. 551–557.
13. Aaronson N.K., Cull A., Kaasa S., Sprangers M.A. The EORTC modular approach to quality of life assessment in oncology. Internat. J. Mental Health. 1994; 23 (2): 75–96.
Review
For citations:
Shabunin A.V., Bеdin V.V., Korzheva I.Yu., Komissarov D.Yu., Vengerov V.Yu. Modern Approaches to the Treatment of Chronic Pancreatitis Complicated by Pancreatic Pseudocysts. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017;22(4):31-38. (In Russ.) https://doi.org/10.16931/1995-5464.2017431-38
Views:
1341
Email this article 