Post-Operative Complications Among Patients Treated with Cystogastrostomy for Pancreatic Pseudocyst
Article Sidebar
Main Article Content
Abstract
Background: Pancreatic pseudocysts represent a clinical challenge, often resulting from pancreatitis, trauma, or surgery. Traditional management strategies have ranged from conservative treatments to surgical interventions, with varying degrees of invasiveness and associated complications. The evolution of minimally invasive techniques, such as laparoscopic cystogastrostomy (LCG), has offered new avenues for treatment, albeit with an imperative need for a thorough understanding of their outcomes and efficacy.
Objective: This study aimed to evaluate the post-operative complications among patients undergoing LCG for pancreatic pseudocysts, contributing to the body of knowledge on patient outcomes and informing clinical practice.
Methods: A descriptive case series was conducted at the Department of General Surgery, Lady Reading Hospital, from April 2023 to October 2023. Seventy patients with pancreatic pseudocysts, confirmed via imaging, were included. Those with previous surgeries for pseudocysts were excluded. All procedures were performed by a single experienced consultant. Post-operative complications were monitored within 24-48 hours, including anastomosis leakage, pneumoperitoneum, bleeding, and perforation. Data were analyzed using SPSS version 25, employing mean and standard deviation for continuous variables, and frequencies and percentages for categorical ones. Chi-square tests were used to explore the association between gender and complications, with significance set at p<0.05.
Results: Among the patients, 55.7% were female, and 44.3% were male. Post-operative complications included anastomosis leakage (11.4%), pneumoperitoneum (7.1%), bleeding (18.6%), and perforation (4.3%). No significant association was found between gender and any complication (anastomosis leakage p=0.68, pneumoperitoneum p=0.25, bleeding p=0.63, perforation p=0.42).
Conclusion: LCG for pancreatic pseudocysts is associated with a notable incidence of complications, including bleeding as the most common. The lack of significant gender disparity in complication rates underscores the procedure's applicability across a diverse patient demographic. These findings advocate for refined surgical techniques and patient management strategies to minimize post-operative risks, contributing to the advancement of care for individuals with pancreatic pseudocysts.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol. 2009;15(1):38-41.
Farias GF, Bernardo WM, De Moura DT, Guedes HG, Brunaldi VO, Visconti TA, et al. Endoscopic versus surgical treatment for pancreatic pseudocysts: Systematic review and meta-analysis. Medicine (Baltimore). 2019;98(8):e14652.
Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol. 2018;3:18.
Cao HS, Kellogg B, Lowy AM, Bouvet M. Cystic neoplasms of the pancreas. Surg Oncol Clin N Am. 2010;19(2):267-95.
Abdelkader A, Hunt B, Hartley CP, Panarelli NC, Giorgadze T. Cystic lesions of the pancreas: differential diagnosis and cytologic-histologic correlation. Arch Pathol Lab Med. 2020;144(1):47-61.
Scholten L, van Huijgevoort NCM, van Hooft JE, Besselink MG, Del Chiaro M. Pancreatic cystic neoplasms: different types, different management, new guidelines. Visc Med. 2018;34(3):173-7.
De Pretis N, Mukewar S, Aryal-Khanal A, Bi Y, Takahashi N, Chari S. Pancreatic cysts: diagnostic accuracy and risk of inappropriate resections. Pancreatology. 2017;17(2):267-72.
Iwashita T, Uemura S, Mita N, Iwasa Y, Ichikawa H, Senju A, et al. Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines. Dig Endosc. 2020;32(2):251-62.
Patel PA, Gibson C, Minhas KS, Stuart S, De Coppi P, Roebuck DJ. Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion. Pediatr Radiol. 2019;49:1816-22.
Sun Y, Yang S, Qi E, Liu F, Zhou F. Comparative diagnostic evaluation with contrast-enhanced ultrasound, computed tomography and magnetic resonance imaging in patients with pancreatic cystic neoplasms. Cancer Manag Res. 2020:12;2889-98.
Suggs P, NeCamp T, Carr JA. A Comparison of Endoscopic Versus Surgical Creation of a Cystogastrostomy to Drain Pancreatic Pseudocysts and Walled-Off Pancreatic Necrosis in 5500 Patients. Ann Surg Open. 2020;1(2):e024.
Simo KA, Niemeyer DJ, Swan RZ, Sindram D, Martinie JB, Iannitti DA. Laparoscopic transgastric endolumenal cystogastrostomy and pancreatic debridement. Surg Endosc. 2014;28:1465-72.
Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583-90.
Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci. 2011;56:902-8.
Lakhtakia S. Complications of diagnostic and therapeutic endoscopic ultrasound. Best Pract Res Clin Gastroenterol. 2016;30:807-823.
van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet. 2018;391:51–58.
Rasch S, Nötzel B, Phillip V, Lahmer T, Schmid RM, Algül H. Management of pancreatic pseudocysts—A retrospective analysis. PLoS ONE. 2017;12(9):e0184374.
Sarzamin MK, Shafi A, Hussain F, Khan MH, Mahmood K. Compare the Post-Operative Morbidity Cystogastrostomy and Cystojejunostomy among Pancreatic Pseudocyst Patients. 2021;15(3):1191-1193.
Rana SS, Shah J, Kang M, Gupta R. Complications of endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections and their management. Ann Gastroenterol. 2019 Sep-Oct;32(5):441-450.
Varadarajulu S, Christein JD, Wilcox CM. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J Gastroenterol Hepatol. 2011;26:1504–1508.