Operative treatment of pseudocysts in patients with chronic pancreatitis

Usatoff, Val; Brancatisano, R.; Williamson, R. C. N.

doi:10.1046/j.1365-2168.2000.01560.x

Cited by 70 publications

(50 citation statements)

References 33 publications

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“…Pancreatic fistula after surgery for chronic pancreatitis is reported to vary from 3 to 8.3% [43, 44, 45, 46]. The incidence of pancreatic fistula following surgery for chronic pancreatitis in a series from Hamburg was 8 (5.2%) of 154 patients and 4 (11%) of 36 patients with extrahepatic portal hypertension compared to 4 (3%) of 118 patients without extrahepatic portal hypertension [47].…”

Section: Complicating Acute and Chronic Pancreatitismentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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Section: Complicating Acute and Chronic Pancreatitismentioning

confidence: 99%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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“…Drainage procedures are favoured by many surgeons for the treatment of chronic pancreatitis, especially for patients presenting with pseudocysts [26,27,28,29]. The mentioned rate of patients with an enlargement of the pancreatic head associated with complications of the surrounding structures indicates that a drainage procedure alone cannot deal with the variety of morphological alterations in the majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Pseudocyst Treatment in Chronic Pancreatitis – Surgical Treatment of the Underlying Disease Increases the Long-Term Success

Schultze-Seemann

Siech

Beger³

2005

Dig Surg

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Background: For reasons of persisting controversies concerning indications for surgery, we evaluated chronic pancreatitis patients following pancreatic head resection or drainage procedure for pseudocysts located in the pancreatic head. Material and Methods: 206 patients (166 male, 40 female) with chronic pancreatitis and pseudocysts in the pancreatic head were operated between April 1982 and July 2001. 169 patients (82%) were treated with the duodenum-preserving pancreatic head resection, a pseudocyst-jejunostomy was performed in 37 patients (18%). Results: The hospital mortality was 0.4%. The late mortality was 19% in a median follow-up of 7.3 years. The rate of patients with complete relief of pain was significantly higher after resection compared to drainage procedure in the long-term follow-up (94 vs. 75%; p = 0.003). With regard to recurrence of pseudocysts, patients had an elevated rate of reoperations following drainage procedure (13 vs. 1%; p = 0.008). The endocrine function was significantly better preserved in patients of the drainage group compared to the resection group (no diabetes 67 vs. 35%, p < 0.01). Conclusion: The resection has, compared to drainage procedures alone, the advantage of low recurrence rate of pseudocysts and a high rate of pain-free patients in the long-term follow-up. However, the risk of diabetes is increased in the resection group.

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“…Pseudocysts account for about two thirds of all pancreatic cystic lesions and complicate chronic pancreatitis in 20–40% of patients [23, 24, 25]. In acute pancreatitis pseudocysts arise in 10–20% of patients [26, 27, 28, 29].…”

Section: Incidencementioning

confidence: 99%