Comparison of Conservative Management versus Drainage in Patients with Pancreatic Pseudocyst

Abstract

Objective: To compare the conservative management of pancreatic pseudocyst with active surgical intervention.
Study Design: Case series study.

Place and Duration of Study: Department of General Surgery Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Apr 2021.

Methodology: A total of 40 patients with pancreatic pseudocysts were included. The size of the pseudocysts, patients’ age,gender, lifestyle risk factors and possible aetiology were recorded. Conservative management was offered initially. The nonregressing and complicated pseudocysts were treated surgically via radiology-assisted external drainage or surgical drainage. Relevant data via close follow-up was recorded.

Results: The mean age of the patients was 61±8.89 years. The pseudocyst size ranged from 4-17cm (median 10cm). Conservative treatment was efficacious in 15(37.5%) with shorter hospital stays (p-value<0.001). All remained pain-free during the one-year follow-up. Surgical intervention was required in 25(62.5%). Radiology-assisted external drainage employed in 15(60%), proved advantageous in 14(93.4%) patients. Recurrence was seen in one patient (6.6%). Other complications included abscess and sepsis. Surgical drainage was used in 10(40%) individuals. Complications included sepsis, abscess and intractable pain. Cumulative intervention-related complications were far higher than conservative management (14,56%, p-value 0.01).The thirty-day mortality in the study patients was 5%, all following surgical intervention.

Conclusion: Conservative management can be successfully employed to avoid the adverse sequelae associated with active interventions.
Keywords: Complications, Conservative management, Pancreatic pseudocyst, Radiological intervention, Surgical
intervention