THE CHOICE OF INVASIVENESS CORRECTION OF COMPLICATED PANCREATIC PSEUDOCYST

Introduction. Surgeons search for capabilities of emergency corrections of complications of pancreas pseudocysts that threaten life, using the minimally invasive methods.

Materials and methods. We studied the treatment results of 76 patients with pancreas pseudocysts complications caused by suffering pancreatic necrosis who were on treatment for the period from 2010 to 2014. Bleeding into the cavity of a pseudocyst was found in 17 patients, suppuration — in 44 cases, perforation into the free abdominal cavity — 6. The combination of suppuration and bleeding — 7 cases, bleeding with perforation — 2 cases.

Results. The most important provisions in the choice of a treatment of these patients are: (1) determination of the severity of a patient’s condition and possible scale of intervention; (2) determination of the localization and pancreas syntopy; (3) identification of complication type. The use of minimally invasive techniques allowed to eliminate life-threatening complications of pancreas pseudocysts in 92% of cases, while in 80% of cases these methods were the final surgery variant. Additional open interventions were needed in cases of recurrent erosive bleeding or occurrence of bowel fistula cysts. Mortality was 5.6%. The implemented principle of retroperitoneal access and retroperitoneoscopy allowed to minimize pancreas zones, which drained poorly, to avoid of para-drain penetration of the contents into the abdominal cavity; residual fistula after removal of the drain had a strong tendency to self-closing.

Conclusion. The use of minimally invasive methods allows to improve the treatment results of patients with such pathology but needs an escalation principle in cases without desirable effect.