Abstract
Background
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.
Methods
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.
Results
There were no significant differences (p < 0.05) in the mean patient age (years), gender, body mass index (BMI) (kg/m2), 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).
Conclusions
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.
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References
Aljarabah M, Ammori BJ (2007) Laparoscopic and endoscopic approaches for drainage of pancreatic pseudocysts: a systematic review of published series. Surg Endosc 21:1936–1944
Pekmezci S, Saribeyoglu K, Karahasanoglu T, Tasci H (2002) Total laparoscopic cystgastrostomy for the treatment of pancreatic pseudocyst. J Laparoendosc Adv Surg Tech 12(2):119–122
Kellogg TA, Horvath KD (2003) Minimal access approaches to complications of acute pancreatitis and benign neoplasms of the pancreas. Surg Endosc 17:1692–1704
Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery. Surg Endosc 18:402–406
Teixeira J, Gibbs KE, Vaimakis S, Rezayat C (2003) Laparoscopic Roux-en-Y pancreatic cyst-jejunostomy. Surg Endosc 17:1910–1913
Tseng D, Sheppard BC, Hunter JG (2005) New approaches to the minimally invasive treatment of pancreatic cancer. Cancer J 11:43–51
Park A, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236:149–158
Kahaleh M, Shami VM, Conaway MR, Tokar J, Rockoff T, De La Rue SA, de Lange E, Bassignani M, Gay S, Adams RB, Yeaton P (2006) Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 38:355–359
Kozarek RA, Brayko CM, Harlan J, Sanowski RA, Cintora I, Kovac A (1985) Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc 31:322–328
Bergman S, Melvin WS (2007) Operative and nonoperative management of pancreatic pseudocysts. Surg Clin North Am 87:1447–1460
Pap A, Topa L, Berger Z, Flautner L, Varro V (1998) Pain relief and functional recovery after endoscopic interventions for chronic pancreatitis. Scand J Gastroenterol Suppl 228:98–106
Catalano MF, Geenen JE, Schmalz MJ, Johnson GK, Dean RS, Hogan WJ (1995) Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis. Gastrointest Endosc 42:214–218
Libera ED, Siqueira ES, Morais M, Rohr MR, Brant CQ, Ardengh JC, Ferrari AP (2000) Pancreatic pseudocysts transpapillary and transmural drainage. HPB Surg 11:333–338
Monkemuller KE, Baron TH, Morgan DE (1998) Transmural drainage of pancreatic fluid collections without electrocautery using the Seldinger technique. Gastrointest Endosc 48:195–200
Beckingham IJ, Krige JEJ, Bornman PC, Terblanche J (1997) Endoscopic management of pancreatic pseudocysts. Br J Surg 84:1638–1645
Smits ME, Raws EA, Tytgat GN, Huibregtse K (1995) The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc 42:202–207
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Melman, L., Azar, R., Beddow, K. et al. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Surg Endosc 23, 267–271 (2009). https://doi.org/10.1007/s00464-008-0196-2
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DOI: https://doi.org/10.1007/s00464-008-0196-2