The Efficacy of Palliative and Definitive Percutaneous Versus Surgical Drainage of Pancreatic Abscesses and Pseudocysts

Lang, Erich K.; Paolini, R. M.; Pottmeyer, Anselm

doi:10.1097/00007611-199101000-00014

Cited by 70 publications

(47 citation statements)

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“…7 Complications in term of secondary infection (8%), paralytic iileus (16%), hemetemesis (5.3%) is found higher in percutaneous drainage than aspiration technique in our study while according to Adams and Anderson et al there was no difference in the incidence of major complications (7.7% Vs 16.7%). 8 Even though this study revealed a significantly higher mortality rate associated with surgical therapy (9%) versus percutaneous therapy (1%; P <0.05).…”

Section: Discussioncontrasting

confidence: 38%

“…A rational algorithm for the management of symptomatic pancreatic pseudocysts is necessary for better outcomes. 5,6 So far, there has been no prospective randomised trial which has evaluated the results of the major modalities of therapy. The purpose of this study is to evaluate where PCD stands in the therapeutic armamentarium, when newer efficient imaging equipments and technical expertise is available.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic pseudocyst: a therapeutic predicament

Mudgal¹,

Gumber

2016

Int Surg J

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Section: Discussioncontrasting

confidence: 38%

Section: Introductionmentioning

confidence: 99%

Pancreatic pseudocyst: a therapeutic predicament

Mudgal¹,

Gumber

2016

Int Surg J

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“…Recently, CT-or ultrasound-guided percutaneous catheter drainage has been used as an alternative to surgical drainage, with early studies reporting a 70% to 90% success rate. [5][6][7][8][9][10][11][12] Subsequent studies with longer follow-up indicate that pseudocyst persistence or recurrence after percutaneous drainage is significantly higher than reported previously. [13][14][15][16] No reliable method of selecting patients likely to respond favorably to percutaneous drainage exists, and the clinical indications for percutaneous drainage remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Drainage of Pancreatic Pseudocysts Is Associated With a Higher Failure Rate Than Surgical Treatment in Unselected Patients

et al. 1999

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ObjectiveThe primary aim was to compare directly the effectiveness of percutaneous drainage versus surgical treatment of pancreatic pseudocysts in unselected patients. The authors also wished to identify factors that may predict a successful outcome with percutaneous drainage. Summary Background DataPancreatic pseudocysts are a common complication of pancreatitis, and recent data suggest that many pseudocysts may be observed or treated successfully by percutaneous drainage. Failures with percutaneous drainage have been recognized increasingly, and a direct comparison of percutaneous and surgical treatment was initiated to identify factors that may affect outcome with these approaches. MethodsA computerized index search of the medical records of patients with a diagnosis of pancreatic pseudocyst was performed from 1984 to 1995. One hundred seventy-three patients were identified retrospectively and assigned to treatment groups: observation (n ϭ 41), percutaneous drainage (n ϭ 66), or surgical treatment (n ϭ 66). Data on demographics, clinical presentation, pseudocyst etiology and characteristics, diagnostic evaluation, management, and outcome were obtained. Treatment failure was defined as persistence of a symptomatic pseudocyst or the need for additional intervention other than the original treatment. ResultsThe etiology of pancreatitis, clinical presentation, and diagnostic evaluation did not differ between groups. Twenty-seven percent had documented chronic pancreatitis, and the etiology of pancreatitis was alcohol in 61% of patients. Mean pseudocyst size was 4.2 Ϯ 1 cm, 8.2 Ϯ 1.1 cm, and 7.4 Ϯ 1.3 cm in the observed, percutaneously treated, and surgically treated groups, respectively. Expectant treatment was successful in 93% of patients. Percutaneous drainage was successful in 42% of patients, whereas surgical treatment resulted in a success rate of 88%. Patients treated by percutaneous drainage had a higher mortality rate (16% vs. 0%), a higher incidence of complications (64% vs. 27%), and a longer hospital stay (45 Ϯ 5 days vs. 18 Ϯ 2 days) than patients treated by surgery. Eighty-seven percent of patients in whom percutaneous drainage failed required surgical salvage therapy. Multiple logistic regression analysis failed to reveal any factors significantly associated with a successful outcome after percutaneous drainage. ConclusionsPercutaneous drainage results in higher mortality and morbidity rates and a longer hospital stay than surgical treatment of pancreatic pseudocysts. The clinical benefit of percutaneous drainage of pancreatic pseudocysts in unselected patients has not been realized, and the role of this treatment should be established in a clinical trial.Pancreatic pseudocysts were considered an uncommon complication of pancreatitis until the advent of computed tomography (CT), but they now are a recognized complication of 16% to 50% of cases of acute pancreatitis and 20% to 40% of cases of chronic pancreatitis.1 The natural history of pancreatic pseudocysts includes an early phase of approximatel...

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“…Initial studies comparing surgical drainage to percutaneous drainage found both procedures to be efficacious [20,21] . However, more recent comparative studies have generally favored percutaneous drainage [22] , with some studies even demonstrating a mortality benefit [23] . Percutaneous drainage has also recently been compared to endoscopic drainage.…”

Section: Percutaneous Drainagementioning

confidence: 99%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

164

154

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Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

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The Efficacy of Palliative and Definitive Percutaneous Versus Surgical Drainage of Pancreatic Abscesses and Pseudocysts

Cited by 70 publications

References 0 publications

Pancreatic pseudocyst: a therapeutic predicament

Pancreatic pseudocyst: a therapeutic predicament

Percutaneous Drainage of Pancreatic Pseudocysts Is Associated With a Higher Failure Rate Than Surgical Treatment in Unselected Patients

Management of pancreatic fluid collections: A comprehensive review of the literature

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