Ivano-Frankivsk national medical university, Ukraine.
Title: Minimally invasive and endoscopic methods of treatment of pancreatic postnecrotic pseudocysts
Nazar Omelchuk is GI surgeon in the Ivano–Frankivsk Regional Clinical Hospital and teacher assistant of General Surgery Department at Ivano–Frankivsk National Medical University. He works on new minimally invasive methods of pancreatic postnecrotic pseudocysts treatment, based on endoscopical approach. He has 3 registered patents, based on new ways of treating patients with acute pancreatitis, complicated with acute pseudocysts
STATEMENT OF THE PROBLEM: Acute necrotic pancreatitis (ANP) remains complicated problem of urgent surgery because of high frequency of systemic, purulent and septic complications, mortality rate, which is in patients with infected pancreonecrosis 14,7 – 26,4 %.
THE PURPOSE: The purpose of this study is to evaluate efficiency and establish indications for minimally invasive methods of treatment of postnecrotic pseudocysts of pancreas.
METHODOLOGY AND THEORETICAL ORIENTATION: For diagnostics were used ultrasonography, diagnostic laparoscopy, helical CT with contrast strengthening. Endoscopic interventions were applied by duodenoscopes “Olympus” under control of X-ray machine
“Siemens BV 300”. Cystodigestive fistulas were created by prickly papilotoms. For providing of long passability of cystodigestive fistula were used two endoprostheses like “pig tail” sized 10 Fr with length 5 – 6 sm. For transpapillary drainage were used pancreatic endoprostheses like “pig tail”, sized 5 – 7 Fr with length 5 sm.
FINDINGS: In 62 (68,2%) patients were applied minimally invasive methods of treatment. Percutaneous external drainage in 33 (53,2 %) patients, endoscopic transmural drainage of postnecrotic pseudocysts in 11 (17,7%) patients. Combined endoscopic interventions were applied in 18 (29,1%) patients. In particular, endoscopic transmural drainage with temporary stenting of pancreatic duct in 11 (61,1%) patients, endobiliary stenting with temporary stenting of pancreatic duct in 3 (16,67%) patients, temporary stenting of pancreatic duct in 3 (16,67%) patients, endoscopic transmural drainage with percutaneous external drainage in 1 (5,56%) patient.
CONCLUSION AND SIGNIFICANCE: Usage of combined minimally invasive methods of treatment of acute necrotic pancreatitis complicated by postnecrotic pseudocysts help to improve results of treatment, reduction of complications amount, contraction of stationary treatment terms and improving of life quality.