[Infected pancreatic pseudocysts: technical notes].
BACKGROUND
Starting from the observation of 9 cases of giant infected pancreatic cysts, which occurred from 1994 to 2004 at the Department of Oncological and Surgical Studies, the Authors' aim has been to evaluate whether a more thorough necrosectomy, carried-out under video-endoscopic control, associated with a nose-gastro-cavity tube, which ensures a continuous cleansing of the newly-formed cavity, and an appropriate positioning of the drainages, could reduce the morbidity and allow a shorter recovery of the infected pseudocysts.


METHODS
Of 73 cases of acute pancreatitis, observed from 1994 to 2004, 9 showed severe and acute pancreatitis, which included giant pseudocysts, as revealed by the abdomen angio-TC. Our nine septic patients underwent cysto-gastro-anastomosis, necrosectomy, intraoperative cleansing of the cavity with an antibiotic solution and positioning of multiple drainages. Three of these patients also underwent a thorough and targeted necrosectomy, assisted by a trans-anastomotic video-endoscopy. A nose-gastro-cavity tube has been placed in all the patients.


RESULTS
The disappearance of the septic state in our three patients who underwent a targeted video-assisted necrosectomy occurred after three days of treatment; moreover, the abdomen angio-TC on the 5th postoperative day showed the disappearance of the necrotic areas. The recovery of these three patients was significantly shorter, compared to those undergoing traditional treatment (cysto-gastro-anastomosis, standard necrosectomy and positioning of abdominal drainages).


CONCLUSIONS
Our surgical video-assisted technique demonstrated that, with a slight increase in the operative time, a better control over sepsis may be accomplished, as well as a reduction of the post-operative morbidity, which leads to shorter hospitalisation of patients with infected pancreatic pseudocysts.
Bonventre
S
S
Università degli Studi di Palermo, Dipartimento di Discpline Chirurgiche e Oncologiche, Cattedra di Chirurgia Generale e Fisiopatologia Chirurgica, Italy.
Frazzetta
M
M
Sammartano
A
A
Di Trapani
B
B
Tavormina
A
A
Sciortino
A S
AS
Frazzetta
F
F
Lucania
M
M
Di Gesù
G
G
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D010180:Pancreatectomy; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods
D000900:Anti-Bacterial Agents