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Khirurgii

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Year 2017 Vol. 25 No 5

GENERAL & SPECIAL SURGERY

I.A. KRYVORUCHKO 1, L.A. PERERVA 2, N.N. GONCHAROVA 1, I.A. TARABAN 1

CURRENT APPROACHES TO THE TREATMENT OF COMPLICATED PANCREATIC PSEUDOCYSTS II TYPE

Kharkiv National Medical University 1, Kharkiv,
SE “National Institute of Surgery and Transplantology named after O.O. Shalimov” 2, National Academy of Medical Sciences of Ukraine, Kiev,
Ukraine

Objectives. Improving the results of surgical treatment of complicated pancreatic pseudocysts (type II), using minimally invasive techniques.
Methods. Treatment outcomes of patients (n=247) with complicated pancreatic pseudocysts (type II) according to classification system offered by A. D’Egidio and M. Schein in 1991 have been analyzed. All patients underwent general clinical blood and urine tests, biochemical blood tests, ultrasound examination, multislice computed tomography, endoscopic fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, endoscopic ultrasonography and morphological studies. To choose the operative treatment method it is necessary to take into account the patient’s age, the type and location of pseudocysts, kind of complications, the state of other organs and systems, severity of organ dysfunction according to SOFA Score. The outcomes of surgical treatment of patients were evaluated according to the classification of Clavien-Dindo (2004).
Results. 119 (48.2%) patients underwent the minimally invasive “step-up surgical approach” technique, in 97 cases (81.5%) surgery was performed in a single stage and in 22 (18.5%) cases – it was a stage before the open surgery. Primary open surgical procedures were performed in 128 (51.8%) patients. Complications occurred in 40 (16.2%) of 247 patients, 1 (0.4%) patient died.
Conclusion. A minimally invasive “step-up surgical approach” technique is preferable in treatment the patients with complicated pancreatic pseudocysts which serves as a basis consisting of a puncture, puncture-drainage percutaneous interventions, transmural anastomosis and transgastric or transduodenal stenting of pseudocysts, X-ray endovascular occlusion of the arrosive blood vessels, with subsequent implementation of open surgical procedures (according to the indications), which together with the minimally invasive interventions should be considered as intercomplementary methods of treatment.
The choice of open interventions depends on disease severity, localization of pseudocysts, the state of the pancreatic ductal system, and the presence of adjacent organs complications.

Keywords: pancreas, chronic pancreatitis, complicated pseudocyst, minimally invasive intervention, open surgeries, external drainage, internal drainage
p. 459-466 of the original issue
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Address for correspondence:
61022, Ukraine, Kharkov,
Science Ave., 4,
Kharkov National Medical University,
Department of Surgery № 2,
Tel.: +38 050 301-90-90,
E-mail: ikryvoruchko@mail.ru,
Igor A. Kryvoruchko
Information about the authors:
Kryvoruchko I.A., MD, Professor, Head of the Surgery Department № 2 of Kharkov National Medical University.
Pererva L.A., PhD, Researcher of SE “National Institute of Surgery and Transplantology named after O.O. Shalimov”, National Academy of Medical Sciences of Ukraine.
Goncharova N.N., MD, Associate Professor of the Surgery Department № 2 of Kharkov National Medical University.
Taraban I.A., MD, Professor of the Surgery Department № 2 of Kharkov National Medical University.
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