It was considered inferior to internal drainage in that external drainage can cause hemorrhage due to mechanical abrasion by the drainage tube, frequent occurrence of secondary infection, persistent pancreatic fistura, which was 10% of all cases, disease rate at 18% and a high 10% mortality. The study revealed a 9% mortality rate for external drainage, often due in turn to the poor condition of the patient.
This last study pointed to internal drainage as the preferable surgical procedure for all uncomplicated cases of pseudocysts (Govil et al. 2004). Cystogastrostomy is the option for cysts, which densely attach to the posterior stomach walls, while cystoduodenostomy should be for pseudocysts in the head and the uncinate process of the pancreas. The authors found that cystojejunestomy would be appropriate for all other types of cysts and for large pseudocysts for proper drainage. All of its 10 patients who underwent internal drainage survived (Govil).
Discussion
Andersson and Cwiklie (2004) found that pancreatic pseudocysts treated by percutaneous cystogastrostomy yielded good results. They believed that this procedure would be a safe and minimally invasive one that will also produce long-term as well as long-term follow-up results.
Cutress (2004) suggested that the laparoscopic drainage of a pseudocyst of the pancreas would be a straightforward procedure, as it has shown to be successful for a large symptomatic pseudocyst with low morbidity.
Pekmeszci (2002) agreed that laparoscopic surgery could be performed when decompression is indicated. The author reported performing laparoscopic procedures by inserting trocars via the anterior gastric wall and operating intraluminially with gastric insufflation and endoscopic guidance. She stressed on the benefits of discussing the feasibility and features of the technique when performed with a total abdominal approach.
Cantasdemic (2003) believed that the PCD would be a safe and effective front-line treatment for patients with pancreatic pseudocysts.
And Govil and associates (2004) underscored the advantages of choosing internal drainage as the appropriate approach to pancreatic pseudocysts and the efficacy of surgical intervention. Six of those who underwent external drainage later exhibited complications, such as pancreatic fistula, septicemia and infection. However, 19 or the 20 patients were reported as doing well during the follow-ups. In comparison with two other studies on the two procedures, Govil and team claimed that their subjects showed no recurrence and with a low 4.7% mortality rate.
The researchers also said that pseudocysts could complicate 7-15% of episodes of acute pancreatitis and 20-25% of chronic pancreatitis (2004). Persistent pseudocysts, they also concluded, could lead to many serious complications, including infection, abscess, and bleeding from erosions into nearby vessels. The present treatment modalities of choice are percutaneous drainage, surgical intervention and endoscopic drainage (Govil et al.).
But the constant observation has been that most cases of pseudocysts resolve by themselves and without interference and, therefore, most patients will recover without need...
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