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

Abstract

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.

Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections

“…Further, the association remained significant, even after adjusting for various clinical and technical confounding factors; and (iv) the duration of the patient follow up in this study was short. In the surgical literature, the rate of PFC recurrence following a cyst gastrostomy is reported to be 15% at 5–7 years' follow up 22 . The most common reason attributed for PFC recurrence is a ductal disruption or stricture.…”

Evidence-based clinical practice guidelines for chronic pancreatitis 2015

“…However, the criterion for the duration of pancreatic stent treatment has been set at approximately 1 year. In ineffective or relapsing cases, a proposal to consider surgical treatment has been made [51][52][53][54][55][56][57][58][59][60][61][62].…”

Chronic Pancreatitis and Pancreatic Pseudocysts

“…Pancreatic pseudocysts are one of the most frequent complications in acute and CP, ranging between 20 and 60% of patients [1] . Most cysts are single and when multiple typically occur in patients with CP.…”

“…The specifi c methods of drainage used depend upon maturity of the cyst wall, location of the cyst, and whether cyst infection is present or not. In a recent series of 206 patients with CP and pseudocysts treated by surgical intervention, 94% of patients had complete pain relief or improved pain after a median follow -up of 7.3 years [1] . There was only one post operative death.…”