MINI-INVASIVE PERCUTANEOUS USP-CONTROLLED DRAINING OF PSEUDOCYSTS OF THE PANCREAS, SUPPLEMENTED WITH LASER VAPORIZATION
Summary. Aim. The aim of this study was to evaluate the results of percutaneous minimally invasive ultrasound-controlled drainage of pancreatic pseudocysts, supplemented by laser vaporization, compared with classical surgical methods of treatment.
Materials and research methods. This work is based on the results of examination and surgical treatment of 51 patients with PCPD, which were divided into two clinical groups.
To optimize the choice of the method of surgical intervention, instrumental research methods were used: ultrasound (PHILIPS HD 11 XE apparatus (Austria), EGDS, ERCP, CT of the pancreas, ECG, X-ray examination of the chest and abdominal cavity, laparoscopy.
Research results. The paper establishes options for choosing a puncture point for a pancreatic pseudocyst with minimal traumatic effect, as a result of which damage to neighboring organs is excluded. Selected the most effective methods of intraoperative use of laser radiation, depending on the formation of the pseudocyst wall and the type of complication.
The main surgical techniques for intraoperative use of percutaneous puncture laser vaporization of the pseudocyst wall, with external and internal drainage, are presented.
Conclusions. When comparing minimally invasive methods of surgical intervention with laparotomic ones, the effectiveness of the former is evidence-based, while the proportion of complications in the early postoperative period and the average length of hospital stay when using minimally invasive interventions are much less. The use of laser irradiation for the purpose of debridement and vaporization (for percutaneous minimally invasive interventions) made it possible to reduce the number of external drainage operations to 41.0 %, and to increase the number of internal digestive drainage operations to 48.7 %. In the long-term period, there was a decrease in the recurrence of pseudocysts to 12.5 %. The proposed method of treating patients with PCPD can be used as an operation of choice in the presence of clinical conditions and technical support.
2. Nealon WH, Walser EM. Duct drainage alone is sufficient in the operative management of pancreatic pseudocyst in patients with chronic pancreatitis. Arch. Surg. 2003;5:614–22.
3. Baron TH, Morgan DE (1999) Endoscopic transgastric irrigation tube placement via PEG for debridement of organized pancreatic necrosis. Gastrointest Endosc 50:574–577.
4. Connor S, Raraty MG, Howes N et al (2005) Surgery in the treatment of acute pancreatitis – minimal access pancreatic necrosectomy. Scand J Surg 94:135-42.
5. Gagner M. Laparoscopic treatment of acute necrotizing pancreatitis. Semin Laparosc Surg. 1996;3:21-8.
6. Horvath KD, Kao LS, Ali A, et al. Laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis. Surg Endosc.2001;15:677-82.
7. Horvath KD, Kao LS, Wherry KL, et al. A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc.2001;15:1221-25.
8. Lee MJ, Wittich GR, Mueller PR. Percutaneous intervention in acute pancreatitis. Radiographics.1998;18:711-24.
9. Parekh D. Laparoscopic-assisted pancreatic necrosectomy: a new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg. 2006; 141:895-902.
10. Seewald S, Groth S, Omar S, et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc. 2005; 62:92-100.
11. Charnley RM, Lochan R, Gray H, et al. Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy.2006; 38:925–928.
12. Windsor JA. Minimally invasive pancreatic necrosectomy. Br J Surg. 2007; 94:132-33.