Choice of minimally invasive method of treatment of pancreatic pseudocysts: a single center, retrospective study

Aim of the study is to evaluate efficacy of different methods of minimally invasive treatment of pancreatic pseudocysts (PPC). Methods. A single center retrospective study of patients with pancreatic pseudocysts (n = 17): 90 males (76.9 %), 27 females (23.1 %) aged 25 to 72 years. The patients underwent external percutaneous drainage (group 1, n = 96) or internal drainage (group 2, n = 21). The diagnosis of pseudocysts included clinical, laboratory (biochemical and bacteriological) and special investigation methods: radiological, endoscopic, ultrasound examination of hepatobiliary zone, computer tomography. Results. Complications in the early postoperative period were observed in patients from both groups 1 and 2. They were related to inefficacy of cystodigestive anastomosis, which required percutaneous drainage in 2 cases (9.5 %), or to formation of pancreatic fistula. Lethal outcomes were not observed. Readmission to surgical department for removal of the drainage was required in 28 (23.9 %) patients from group 1. Internal drainage is considered more advantageous for PPC decompression compared to external one due to persistence of pancreatic fluid passage through gastrointestinal tract. External drainage is associated with frequent external pancreatic fistulae formation as well as prolonged hospital stay and treatment in an outpatient setting worsening the quality of life, but it is an intervention of choice in somatically severely ill patients, in fast growing cyst, imperfectly formed wall and threatening cyst rupture into abdominal cavity or abscess. These aspects prevent from refusal from external drainage for PPC treatment. Conclusion. When choosing the optimal time and type of surgical intervention in PPC, the surgeon should evaluate localization, sizes, maturation of PC wall and its relation to pancreatic duct, somatic state and patient’s individual features

Hemorrhagic complications of pancreatitis in surgical practice

The objective of the study was to detect the frequency and sources of hemorrhagic complications in patients with pancreatitis, evaluate the tactics and effectiveness of methods of hemostasis. Material and methods. A retrospective analysis of hemorrhagic complications of pancreatitis was carried out in 40 patients. Results. Bleeding developed mainly on the background of infected acute necrotic collections (77.8 %), the main source of bleeding was the splenic artery (37.0 %). Emergency laparotomy for bleeding was performed in 9 (22.5 %) patients, selective angiography was performed in 10 patients, it was effective only in 5 (50 %) cases. 12 (44.4 %) deaths were recorded in cases of arrosive bleeding. Conclusion. The preferred tactics in case of bleeding from the retroperitoneal space during minimally invasive treatment is crossclamping of drains and endovascular hemostasis