Katy A Marino1, Leah E Hendrick1, Stephen W Behrman2. 1. Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA. 2. Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA. Electronic address: sbehrman@uthsc.edu.
Abstract
BACKGROUND: Management of pancreatic pseudocysts (PP) is unclear when located in areas outside the lesser sac, infected, or when portal venous (PV) occlusion is present. METHODS: Patients having internal drainage of PP. Management and outcome were assessed relative to location, presence of infection, and/or PV occlusion. RESULTS: No patient required transfusion, and there were no readmissions in 9 patients with PV occlusion. Eleven patients had infected PP including 5 extending outside the lesser sac. Six had postoperative imaging, 4 readmission, and 3 required adjunct postoperative percutaneous drainage. All but 2 with PP beyond the lesser sac had Roux-en-Y cystjejunostomy including 4 with 2 anastomoses. Nine, 4, and 5 required reimaging, readmission, and postoperative therapeutic intervention, respectively. CONCLUSIONS: (1) Open PP drainage in the face of PV occlusion confers a low risk of bleeding and a minimal need for reimaging or readmission; (2) internal drainage of infected PP is a viable option to external drainage; and (3) PP extending beyond the lesser sac can most often be managed successfully by Roux-en-Y drainage but may require additional intervention.
BACKGROUND: Management of pancreatic pseudocysts (PP) is unclear when located in areas outside the lesser sac, infected, or when portal venous (PV) occlusion is present. METHODS:Patients having internal drainage of PP. Management and outcome were assessed relative to location, presence of infection, and/or PV occlusion. RESULTS: No patient required transfusion, and there were no readmissions in 9 patients with PV occlusion. Eleven patients had infected PP including 5 extending outside the lesser sac. Six had postoperative imaging, 4 readmission, and 3 required adjunct postoperative percutaneous drainage. All but 2 with PP beyond the lesser sac had Roux-en-Y cystjejunostomy including 4 with 2 anastomoses. Nine, 4, and 5 required reimaging, readmission, and postoperative therapeutic intervention, respectively. CONCLUSIONS: (1) Open PP drainage in the face of PV occlusion confers a low risk of bleeding and a minimal need for reimaging or readmission; (2) internal drainage of infected PP is a viable option to external drainage; and (3) PP extending beyond the lesser sac can most often be managed successfully by Roux-en-Y drainage but may require additional intervention.