Supervisors info:
Χρήστος Π. Τσιγκρής, Καθηγητής (Επιβλέπων). Νικόλαος Ι. Νικητέας, Αναπληρωτής Καθηγητής, Ιωάννης Γκρινιάτσος, Επίκουρος Καθηγητής
Summary:
Aim of this research is the systematic review of the bibliography concerning
with minimally invasive and endoscopic techniques in the management of the
pancreatic pseudocysts.
There has been a review of the on line databases (pub med, Scopus). The search
terms are: “pancreatic pseudocyst” with “Seldinger”, “diathermic”,
“transpapillary”, “laparoscopic”, “endoscopic ultrasonography”.
A pancreatic pseudocyst is defined as a fluid collection >4 weeks old and
surrounded by a defined wall , a maturing collection of pancreatic juice
encased by reactive granulation tissue, occurring in or around the pancreas as
a consequence of inflammatory pancreatitis or ductal leakage.
Pancreatic pseudocysts can produce many clinical problems depending upon the
location and extent of the fluid collection and the presence of infection, such
as abdominal pain, duodenal or biliary obstruction, vascular occlusion, or
fistula formation into adjacent viscera, the pleural space, or pericardium.
Spontaneous infection may develop, pseudoaneurysm , pancreatic ascites and
pleural effusion
Surgeons are based upon a classic study which noted that pseudocysts persisting
beyond six weeks rarely resolved and had a complication rate of nearly 50
percent during continued observation . Beyond 13 weeks, no further resolution
was seen, and the complication rate rose sharply. Operative intervention was
recommended following an observation period of six weeks to ensure that
spontaneous resolution did not occur and to allow time for the pseudocyst wall
to mature, permitting direct suturing of a cystenterostomy.
However, many support a more conservative approach with expectant follow-up in
patients who do not have a cystic neoplasm, pseudoaneurysm, or more than
minimal symptoms.
In the past surgical drainage was the only form of therapy. There are now two
additional treatment options which have achieved increasing popularity:
radiologic imaging with percutaneous catheter drainage and endoscopic drainage.
Drainage can also be accomplished laparoscopically, an approach first described
in 1994.
Percutaneous catheter drainage is as effective as surgery in draining and
closing both sterile and infected pseudocysts. It is important to maintain
catheter patency with frequent gentle irrigation.
Endoscopic ultrasonography (EUS) has become increasingly popular in evaluating
cystic lesions of the pancreas since it can delineate complex wall structures
and internal cyst contents.
Intervention is suggested for patients with pseudocysts who are symptomatic or
those with an infected pseudocyst. We suggest conservative management, if the
pancreatic duct is intact to the tail without pseudocyst communication.
Patients with relatively small pseudocysts in communication with the main
pancreatic duct are considered good candidates for transpapillary stent
placement as initial therapy. We attempt transmural puncture in patients who
have large, symptomatic pseudocysts compressing the stomach or duodenum when
there is close apposition seen on CT scan.
Endoscopic drainage of pancreatic pseudocysts by expert endoscopists has become
an accepted alternative to surgery when intervention is indicated. Endoscopic
drainage is the procedure of choice in the management of most patients with
pseudocysts of the pancreas.
Keywords:
Pancreatic , Pseudocyst, Laparoscopic, Diathermic, Transpapillary
