DOI: http://dx.doi.org/10.18203/2349-2902.isj20214358

Indications and outcome of surgical management of local complications of acute pancreatitis: a single-centre experience

Roshan Ghimire, Yugal Limbu, Anuj Parajuli, Dhiresh K. Maharjan, Prabin B. Thapa

Abstract


Background: Acute pancreatitis is a common and challenging disease that can develop both local and systemic complications. According to the Atlanta classification, local complications include peri-pancreatic collection, acute necrotic collection, pseudocyst and walled-off necrosis.

Methods: A hospital-based retrospective study was conducted in the department of surgery at Kathmandu medical college teaching hospital. Patients were recruited using purposive sampling method and those who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis from June 2017 to July 2021. The indication, perioperative outcome and associated complications were evaluated in all the cases.

Results: Between June 2017 to July 2021, 432patients were admitted to the surgery department with acute pancreatitis or with complications of acute pancreatitis. Twenty-one patients required surgical intervention in the form of external drainage, cysto-enterostomy, VARD or open necrosectomy due to failure of endoscopic or radiological intervention or due to positions of lesions being inaccessible to these techniques. All patients had clinical improvement following surgery with an acceptable complication rate given the severity of the disease.

Conclusions: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.


Keywords


Acute pancreatitis, Local complications, Surgical management

Full Text:

PDF

References


Banks PA, Bollen TL, Dervenis C. Classification of acute pancreatitis - 2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.

Colvin SD, Smith EN, Morgan DE, Porter KK. Acute pancreatitis: an update on the revised Atlanta classification. Abdom Radiol (NY). 2020;45(5):1222-31.

Głuszek S, Nawacki Ł, Matykiewicz J, Kot M, Kuchinka J. Severe vascular complications of acute pancreatitis. Pol Prz Chir Polish J Surg. 2015;87(10):485-90.

IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(2):48-53.

Lancaster A, Zwijacz M. Acute pancreatitis and fluid-filled collections: etiology and endoscopic management. Gastroenterol Nurs. 2019;42(5):417-9.

Baron TH, DiMaio CJ, Wang AY, Morgan KA. American gastroenterological association clinical practice update: Management of Pancreatic Necrosis. Gastroenterol. 2020;158(1):67-75.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.

Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015;386:85-96.

Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis. Gastroenterology. 2019;156(4):1016-26.

Dalsania R, Willingham FF. Treatment of walled-off pancreatic necrosis. Curr Opin Gastroenterol. 2019;35(5):478-82.

Barthet M, Lamblin G, Gasmi M, Vitton V, Desjeux A, Grimaud JC. Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc. 2008;67(2):245-52.

Nealon WH, Walser E. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg. 2005;241(6):948-57.

Catalano MF, Geenen JE, Schmalz MJ, Johnson GK, Dean RS, Hogan WJ. Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis. Gastrointest Endosc. 1995;42(3):214-8.

Lopes CV, Pesenti C, Bories E, Caillol F, Giovannini M. Endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. Arq Gastroenterol. 2008;45(1):17-21.

Antillon MR, Shah RJ, Stiegmann G, Chen YK. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc. 2006;63(6):797-803.

Krüger M, Schneider AS, Manns MP, Meier PN. Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access. Gastrointest Endosc. 2006;63(3):409-16.

Matsuoka L, Alexopoulos SP. Surgical Management of Pancreatic Pseudocysts. Gastrointest Endosc Clin N Am. 2018;28(2):131-41.

Andersson B, Andrén-Sandberg Å, Andersson R. Survey of the management of pancreatic pseudocysts in Sweden. Scand J Gastroenterol. 2009;44(10):1252-8.

Yoon SB, Chang JH, Lee IS. Treatment of Pancreatic Fluid Collections. Korean J Gastroenterol. 2018; 72(3):97-103.

Obermeyer RJ, Fisher WE, Salameh JR, Jeyapalan M, Sweeney JF, Brunicardi FC. Laparoscopic pancreatic cystogastrostomy. Surg Laparosc Endosc Percutan Tech. 2003;13(4):250-3.