Study of Surgery for Pancreatic Pseudocyst Following Acute Pancreatitis

Noriyuki Okada, Michihiko Wada, Yoshikazu Masai, Tokiharu Miyahara, Takashi Hashimoto, Shiro Imai, Ken Yanagibashi, Yutaka Konishi and Tatehiro Kajiwara

Department of Surgery, Kobe City General Hospital

Objective: We classified pancreatic pseudocysts following acute pancreatitis to determine surgical indications and prognosis. Patients and methods: Subjects were 38 patients with pancreatic pseudocyst following acute pancreatitis in the last 15 years classified into surgically treated and non treated groups. We discuss the features of pseudocysts, surgical indications, surgical procedures, and prognosis. Results: Among subjects, 21 (55%) were not cured by conservative therapy, necessitating surgery. Pseudocysts necessitated surgery in cases involving a solitary pseudocyst, in the pancreatic tail, communicating to the pancreatic duct, and having a large maximal diameter. Surgery involved resection in 13 subjects-distal pancreatectomy in 11 and pancreaticoduodenectomy in 2; cystenterostomy in 4; and surgical drainage in 4. Operative indications were classified into 11 cases of symptomatic delayed healing, 4 of abscess formation, 3 of bleeding from the pseudocyst, and 3 of suspected tumor. Emergency surgery was conducted in 2 patients with bleeding and 1 with infection. Although all patients healed and discharged hospital, among those undergoing surgery, 8 relapsed into acute pancreatitis, 3 of whom had new pseudocyst. Conclusions: Surgery may be considered in large pancreatic pseudocysts with delayed healing, especially in relapsed patients. Intracystic bleeding, infection, or abscess indicates a surgical emergency. Since some patients undergoing surgery relapse into pancreatitis, treatment is important for both pseudocysts and acute pancreatitis.

Key words
acute pancreatitis, pancreatic pseudocyst, operative indication

Reprint requests
Noriyuki Okada Department of Surgery, Kobe City General Hospital 4-6 Minatojimanakamachi, Chuo-ku, Kobe City, 650-0046 JAPAN

Accepted
November 27, 2002

To read the PDF file you will need Abobe Reader installed on your computer.