Original article
Surgical treatment of pancreatic pseudocysts
Tratamiento quirúrgico del seudoquiste de páncreas
José Luis Martínez-Ordaz
, Carlos Toledo-Toral, Norma Franco-Guerrero, Mauro Tun-Abraham, Luis Manuel Souza-Gallardo
Corresponding author
jlmo1968@hotmail.com
Corresponding author at: Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, 3.er piso, Colonia Doctores, Del. Cuauhtémoc, México, D.F. C.P. 06725, Mexico. Tel.: +52 55 5627 6900ext.21436.
Corresponding author at: Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, 3.er piso, Colonia Doctores, Del. Cuauhtémoc, México, D.F. C.P. 06725, Mexico. Tel.: +52 55 5627 6900ext.21436.
Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., Mexico
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Cuauhtémoc 330, 3.er piso, Colonia Doctores, Del. Cuauhtémoc, México, D.F. C.P. 06725, Mexico. Tel.: +52 55 5627 6900ext.21436." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento quirúrgico del seudoquiste de páncreas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The pancreatic pseudocyst is defined as a localised collection of fluid rich in amylase and other enzymes surrounded by a fibrous wall or granulation tissue, and resulting from an episode of acute pancreatitis, chronic pancreatitis, pancreatic trauma or extrinsic obstruction of the pancreatic duct.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,2</span></a> It has to have persisted for a minimum of 4 weeks with or without communication to the pancreatic duct system.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The current prevalence of pancreatic pseudocysts is 10–20% in patients with chronic pancreatitis. Alcohol consumption is the cause in 65% of cases, followed by vesicular lithiasis in 15%.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical, biochemical and radiological findings.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Treatment strategies for patients with pancreatic pseudocyst have changed and continue to evolve. Management includes percutaneous drainage, internal endoscopic drainage, internal and external drainage, surgery and resection.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This study reports the experience and results obtained in patients diagnosed with a pancreatic pseudocyst who underwent surgical treatment in a third level hospital over a period of 13 years.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective cohort was formed from all patients diagnosed with a pancreatic pseudocyst who underwent surgery in the period between 1 January 2000 and 31 December 2013 in the Gastric Surgery Department of the <span class="elsevierStyleItalic">Hospital de Especialidades de Centro Médico Nacional Siglo XXI</span>, Mexican Social Security Institute.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Demographic data were obtained (age and gender, aetiology (acute, chronic, idiopathic or traumatic pancreatitis), clinical presentation (pain, early satiety, jaundice, abdominal tumour), laboratory data (haemoglobin, leukocytes, serum amylase and lipase), radiological findings (location, number – single or multiple- and size), indication and type of surgical procedure undertaken (internal drainage, cystogastroanastomosis, cystoduodenoanastomosis, cystojejunoanastomosis – external drainage or resection) and complications (wound infection, postoperative bleeding, pancreatic or intestinal fistula, dehiscence of the surgical wound, pulmonary and infectious thromboembolisms). Recurrence rate and mortality were evaluated during follow-up.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data were collected on a database and the statistical analysis was performed using SPSS software version 16 (SPSS Inc., Chicago, Ill, U.S.A.). The Chi squared test was used for comparisons for nominal variables and the Student's <span class="elsevierStyleItalic">t</span>-test for continuous variables. Postoperative complications and recurrence were identified as dependent variables. A <span class="elsevierStyleItalic">p-</span>value <0.05 was considered significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">One hundred and thirty-nine patients were studied, 81 males (58%) and 58 women (42%), with a median age of 44.5 (range 18–85). In 74 (53%) patients the aetiology was secondary to chronic pancreatitis, in 52 (37%) acute pancreatitis, in 11 (8%) idiopathic, and in 2 (1%) patients it was abdominal trauma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The main symptoms were: abdominal pain in 101 cases (73%), weight loss in 53 (38%), postprandial fullness or early satiety in 48 (35%), nausea and vomiting in 47 (34%), and fever in 26 (19%). The predominant sign on physical examination was abdominal tumours in the epigastrium in 37 cases (27%); 2 cases (1%) presented with symptoms of acute abdomen secondary to rupture.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The laboratory tests revealed hyperamylasaemia in 110 patients (79%) and hyperlipasaemia in 109 (78%); anaemia in 25 cases (18%) and leukocytosis greater than 10,500/mm<span class="elsevierStyleSup">3</span> in 56 (40%).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Computed tomography scans (CT) were performed on 104 patients (79%) and abdominal ultrasound on 84 (60%). Endoscopic ultrasound and magnetic resonance were used less often and only as a diagnostic complement. The median size was 18<span class="elsevierStyleHsp" style=""></span>cm (range 7–29<span class="elsevierStyleHsp" style=""></span>cm) and the most common location was in the body and tail in 75 cases (54%), body in 33 (24%), head and body in 22 (16%) and head of pancreas in 9 cases (6%).</p><p id="par0060" class="elsevierStylePara elsevierViewall">The surgical treatment chosen was internal drainage in 111 patients (80%). Cystojejunoanastomosis was performed in 96 (69%), cystogastroanastomosis in 11 (8%) and cystoduodenoanastomosis in 4 (3%). Twenty patients (14%) underwent external surgical drainage and 8 (6%) resection.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Forty-one (29%) patients presented postoperative complications. Sixteen (12%) patients developed a pancreatic fistula, 9 (6%) infection, 6 (4%) postoperative haemorrhage, and 6 (4%) non-surgical complications, of which 4 were pneumonia, one cardiac arrhythmia and one pulmonary thromboembolism. Seven patients suffered recurrence (6%). Two patients died for a mortality of 1%; one patient due to haemorrhage and the other due to septic shock. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the surgical treatment associated with postoperative complications, recurrence and mortality.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the analysis we performed, the factor associated with postoperative complications was a greater presence of complications when the aetiology was secondary to chronic pancreatitis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.04) and with the type of surgical procedure performed – cystojejunoanastomosis had fewer postoperative complications (21%) compared with external drainage (55%, principally pancreatic fistula) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). There were no differences in terms of recurrence and mortality, in relation to aetiology, size, location, and type of surgical procedure undertaken.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Several complications can appear after an episode of pancreatitis of which the pancreatic pseudocyst is one of the most common. The pathophysiology, in most patients, is the result of the lesion or alteration to the normal anatomy of the pancreatic duct.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The aetiology of the pancreatic pseudocyst is directly associated with the cause of the pancreatitis; the consumption of alcohol is the cause in 65% of cases, followed by vesicular lithiasis in 15%. Due to improved imaging techniques, the current prevalence is 10–20% in patients after acute pancreatitis and 20–40% in patients with chronic pancreatitis.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3</span></a> In our study the incidence was 53% associated with chronic pancreatitis and 47% with acute pancreatitis. The prevalence of pseudocysts is higher in males, between the fourth and fifth decades of life,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3,4</span></a> and both of these results are compatible with our study.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Diagnosis is made based on clinical, biochemical and radiological findings.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> The clinical presentation is variable, from asymptomatic patients to symptoms of abdominal emergency due to complications.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3</span></a> The predominant symptoms reported in the literature are abdominal pain, which presents in up to 90% of patients, early satiety, nausea and vomiting (50–70%), weight loss (20–50%), jaundice (10%) and fever (10%).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> On physical examination, only 25–50% presented a palpable abdominal mass.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> There can also be sepsis secondary to infection, hypovolemic shock due to bleeding<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> and acute abdomen after spontaneous rupture of the pseudocyst.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> The clinical findings in our study are similar to those reported in the literature reviewed and are important in patient assessment.</p><p id="par0090" class="elsevierStylePara elsevierViewall">There are currently no specific laboratory studies to establish a diagnosis of pancreatic pseudocyst; however, a persistently elevated concentration of amylase and lipase can be observed in up to 50% of patients. Other findings include mild leukocytosis and alterations in liver function tests.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,4</span></a> There were elevated serum levels of the abovementioned pancreatic enzymes in most of our patients. Measurement of these is an important part of the diagnostic protocol and therefore is recommended in our study. The other biochemical findings in our study were non-specific.</p><p id="par0095" class="elsevierStylePara elsevierViewall">With regard to radiological studies, CT is the scan of choice for patients with a suspected pseudocyst. It provides important information about the relationship of the lesion with adjacent structures, the characteristics of the biliary and pancreatic system, the presence of calcifications, the size of the pseudocyst, its extension and location; all of these are important factors in planning treatment. The sensitivity and specificity reported for CT scanning is 90–100% and 98–100%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,4</span></a> Another widely-used study is ultrasound which has a sensitivity of 75–90% and specificity of 92–98%. Magnetic resonance and cholangiopancreatography are viable options for study and treatment<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,2,4</span></a>; however, they were not used very much in our population. Due to the sensitivity and specificity of CT scanning reported in the literature and its availability in our hospital, tomography was our radiological study of choice. In some cases other radiological tools were used, to complement the diagnostic protocol.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Management strategies have changed and continue to evolve.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> The American College of Gastroenterology's guidelines for the management of pancreatitis of 2013<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> state that an asymptomatic pancreatic pseudocyst can be managed conservatively irrespective of its size, location or extension to neighbouring structures. This is contrary to what was reported previously, when it was recommended that the lesion should be drained if it was greater than 6<span class="elsevierStyleHsp" style=""></span>cm in size or had persisted longer than 6 weeks.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> These guidelines recommend invasive management to treat pancreatic pseudocysts only if there are symptoms due to the lesion itself or because it has extended to neighbouring structures and is compromising normal gastrointestinal physiology (infected pseudocyst, bleeding, biliary obstruction or delayed gastric emptying).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9–12</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">At present management includes percutaneous, endoscopic or surgical drainage, each of which has its different advantages and disadvantages.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> We did not find any controlled prospective studies that directly compare one with another. It is not easy to establish which therapeutic drainage method is better than the rest, however, the management chosen will depend on the patient's clinical characteristics and, ideally, on the anatomy of the pancreatic duct. According to Park and Heniford,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> Nealon and Walser described a classification where they took into account the presence of stenosis or obstruction of the pancreatic duct and the communication of the pseudocyst to it. Therefore, appropriate patient selection, the underlying cause of the pancreatitis, the location of the pseudocyst, and the presence or absence of obstruction of the pancreatic duct are important factors which will determine the outcome of the drainage method chosen.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The treatment of choice in our study was surgery; this is still considered the gold standard, and is divided between internal, external drainage and resection. Internal drainage can be performed by communication between the pseudocyst and the stomach (cystogastroanastomosis), jejunum (cystojejunoanastomosis) or duodenum (cystoduodenoanastomosis).<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">8,14,15</span></a> The choice of any of these techniques will depend on the location of the pseudocyst, the adjacent structures and the surgeon's preference. If resection is chosen, this will depend on the location of the pseudocyst, and a distal pancreatectomy or even pancreaticoduodenectomy can be performed.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The surgical drainage chosen in our study was cystojejunoanastomosis in almost 7 out of 10 of our patients. A lower rate of complications is reported in the literature when this approach is chosen compared to other types of internal drainage.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> Nevertheless, our study did not demonstrate a difference in terms of the rate of complications compared with other internal drainage approaches. However, we did find these differences when compared with external drainage, where we found a high prevalence of pancreatic fistula; therefore this is not a procedure that we perform frequently in our hospital.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Surgical drainage has a mortality of 5–9%, with a mean of complications of around 11–24% and 5–8% recurrence.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,15</span></a> The recurrence reported in our study was 6% with 1% mortality, this coincides with that reported in the literature.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The rate of complications and recurrence in our study coincides with that reported in the literature. Open or laparoscopic surgical management with internal drainage (mainly towards the jejunum) is a viable and very important option in patients with a diagnosis of pancreatic pseudocyst, has a high resolution rate and low prevalence of postoperative complications.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres692528" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec700357" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres692529" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec700358" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-07" "fechaAceptado" => "2015-09-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec700357" "palabras" => array:3 [ 0 => "Pancreatic pseudocyst" 1 => "Pancreatitis" 2 => "Surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec700358" "palabras" => array:3 [ 0 => "Seudoquiste pancreático" 1 => "Pancreatitis" 2 => "Drenaje quirúrgico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A pancreatic pseudocyst is the collection of pancreatic secretions surrounded by fibrous tissue caused by pancreatic disease that affects the pancreatic duct. Clinical presentation is variable. Management includes percutaneous, endoscopic or surgical drainage and resection.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Review of a cohort of patients with pancreatic pseudocyst in a third level hospital. An analysis was performed on the demographic data, aetiology, clinical presentation, radiological and laboratory findings, type of surgical procedure, complications, recurrence and mortality. The statistical analysis was performed using Chi squared and Student's <span class="elsevierStyleItalic">t</span>-tests, with a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 139 patients were included, of whom 58% were men and 42% were women, with median age of 44.5 years. Chronic pancreatitis was the most common aetiology, present in 74 patients (53%). The main complaint was abdominal pain in 73% of patients. Median size was 18<span class="elsevierStyleHsp" style=""></span>cm (range 7–29) and the most frequent location was body and tail of the pancreas. Internal surgical drainage was selected in 111 (80%) patients, of whom 96 were cystojejunostomy, 20 (14%) had external surgical drainage, and 8 (6%) resection. Complications were, pancreatic fistula (12%), haemorrhage (4%), infection (4%), and other non-surgical complications (4%). Complication rate was higher if the cause was chronic pancreatitis or if the management was external surgical drainage. Recurrence rate was 6%, and a mortality rate of 1%.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Surgical management is a viable option for the management of pancreatic pseudocyst with a low complication and recurrence rate.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El seudoquiste de páncreas es la colección de secreciones pancreáticas rodeada de una pared fibrosa secundaria a enfermedad aguda o crónica. El tratamiento incluye drenaje percutáneo, endoscópico o quirúrgico y resección.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo es presentar la experiencia quirúrgica en pacientes con seudoquiste de páncreas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cohorte retrospectiva de 139 pacientes con diagnóstico de seudoquiste pancreático, durante 13 años en un hospital de tercer nivel. Se estudiaron datos demográficos, etiología, presentación clínica, datos radiológicos y de laboratorio, indicación, tipo de procedimiento quirúrgico realizado, complicaciones, recurrencia y mortalidad. Se realizó prueba de Chi cuadrada para las variables nominales y T de Student para variables continuas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Fueron 81 hombres (58%) y 58 mujeres (42%), con una mediana de edad de 44.5 años. En 74 pacientes (53%) la etiología fue pancreatitis crónica. El síntoma más frecuente fue dolor abdominal en el 73%. La mediana de tamaño fue 18<span class="elsevierStyleHsp" style=""></span>cm (7-29) y la localización más frecuente fue: cuerpo y cola en 75 pacientes (54%). El tratamiento fue: drenaje interno en 111 pacientes (80%), (96 cistoyeyunoanastomosis), en 20 (14%) drenaje externo y resección en 8 (6%). Las complicaciones fueron: fístula pancreática (12%), hemorragia postoperatoria (4%), infección (4%) y complicaciones no quirúrgicas (4%). La tasa de complicaciones fue mayor cuando el diagnóstico era pancreatitis crónica y se realizó drenaje quirúrgico externo (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Hubo recurrencia en 7 pacientes (6%). Dos pacientes fallecieron (1%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El tratamiento quirúrgico es una opción en el manejo del seudoquiste pancreático, con baja tasa de complicaciones y recurrencia.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Ordaz JL, Toledo-Toral C, Franco-Guerrero N, Tun-Abraham M, Souza-Gallardo LM. Tratamiento quirúrgico del seudoquiste de páncreas. Cir Cir. 2016;84:288–292.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical procedure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size in cm (range) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complications (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recurrence (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mortality (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Internal drainage</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cystojejunoanastomosis (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (7–27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cystogastroanastomosis (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (10–25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cystoduodenoanastomosis (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (12–23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">External drainage</span> (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">20</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (8–29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Resection</span> (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">8</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.5 (7–24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total</span> (<span class="elsevierStyleItalic">139</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (7–29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1129789.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Surgical treatment, preoperative and postoperative characteristics in 139 patients with pancreatic pseudocyst.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pancreatic pseudocyst" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Habashi" 1 => "P.V. Draganov" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "38" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19115466" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of acute pancreatitis-2012: revision of Atlanta classification and definitions by international consensus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Banks" 1 => "T.L. Bollen" 2 => "C. Dervenis" 3 => "H.G. Gooszen" 4 => "C.D. Johnson" 5 => "M.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 34 | 8 | 42 |
| 2024 September | 86 | 12 | 98 |
| 2024 August | 61 | 10 | 71 |
| 2024 July | 63 | 13 | 76 |
| 2024 June | 75 | 15 | 90 |
| 2024 May | 57 | 7 | 64 |
| 2024 April | 66 | 9 | 75 |
| 2024 March | 64 | 11 | 75 |
| 2024 February | 70 | 12 | 82 |
| 2024 January | 99 | 14 | 113 |
| 2023 December | 69 | 12 | 81 |
| 2023 November | 92 | 25 | 117 |
| 2023 October | 92 | 22 | 114 |
| 2023 September | 88 | 14 | 102 |
| 2023 August | 96 | 12 | 108 |
| 2023 July | 104 | 8 | 112 |
| 2023 June | 103 | 6 | 109 |
| 2023 May | 127 | 16 | 143 |
| 2023 April | 92 | 7 | 99 |
| 2023 March | 127 | 6 | 133 |
| 2023 February | 76 | 10 | 86 |
| 2023 January | 91 | 16 | 107 |
| 2022 December | 81 | 25 | 106 |
| 2022 November | 74 | 13 | 87 |
| 2022 October | 52 | 18 | 70 |
| 2022 September | 62 | 20 | 82 |
| 2022 August | 58 | 11 | 69 |
| 2022 July | 56 | 11 | 67 |
| 2022 June | 38 | 10 | 48 |
| 2022 May | 31 | 21 | 52 |
| 2022 April | 38 | 12 | 50 |
| 2022 March | 36 | 9 | 45 |
| 2022 February | 28 | 7 | 35 |
| 2022 January | 23 | 7 | 30 |
| 2021 December | 23 | 8 | 31 |
| 2021 November | 29 | 5 | 34 |
| 2021 October | 29 | 8 | 37 |
| 2021 September | 11 | 11 | 22 |
| 2021 August | 15 | 5 | 20 |
| 2021 July | 11 | 9 | 20 |
| 2021 June | 15 | 9 | 24 |
| 2021 May | 29 | 10 | 39 |
| 2021 April | 100 | 27 | 127 |
| 2021 March | 47 | 6 | 53 |
| 2021 February | 32 | 9 | 41 |
| 2021 January | 26 | 14 | 40 |
| 2020 December | 28 | 12 | 40 |
| 2020 November | 15 | 14 | 29 |
| 2020 October | 15 | 3 | 18 |
| 2020 September | 19 | 9 | 28 |
| 2020 August | 24 | 3 | 27 |
| 2020 July | 23 | 1 | 24 |
| 2020 June | 12 | 4 | 16 |
| 2020 May | 7 | 7 | 14 |
| 2020 April | 13 | 4 | 17 |
| 2020 March | 14 | 8 | 22 |
| 2020 February | 10 | 8 | 18 |
| 2020 January | 8 | 9 | 17 |
| 2019 December | 15 | 22 | 37 |
| 2019 November | 8 | 22 | 30 |
| 2019 October | 9 | 19 | 28 |
| 2019 September | 10 | 8 | 18 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 12 | 6 | 18 |
| 2019 June | 35 | 22 | 57 |
| 2019 May | 95 | 35 | 130 |
| 2019 April | 41 | 12 | 53 |
| 2019 March | 3 | 2 | 5 |
| 2019 February | 9 | 6 | 15 |
| 2019 January | 6 | 2 | 8 |
| 2018 December | 7 | 6 | 13 |
| 2018 November | 10 | 2 | 12 |
| 2018 October | 5 | 5 | 10 |
| 2018 September | 3 | 6 | 9 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 2 | 1 | 3 |
| 2018 June | 3 | 3 | 6 |
| 2018 May | 2 | 3 | 5 |
| 2018 April | 2 | 2 | 4 |
| 2018 March | 9 | 0 | 9 |
| 2018 February | 0 | 3 | 3 |
| 2018 January | 7 | 2 | 9 |
| 2017 December | 2 | 0 | 2 |
| 2017 November | 9 | 2 | 11 |
| 2017 October | 4 | 3 | 7 |
| 2017 September | 2 | 2 | 4 |
| 2017 August | 1 | 0 | 1 |
| 2017 July | 9 | 3 | 12 |
| 2017 June | 8 | 2 | 10 |
| 2017 May | 17 | 1 | 18 |
| 2017 April | 14 | 6 | 20 |
| 2017 March | 8 | 58 | 66 |
| 2017 February | 10 | 3 | 13 |
| 2017 January | 8 | 1 | 9 |
| 2016 December | 18 | 3 | 21 |
| 2016 November | 21 | 8 | 29 |
| 2016 October | 31 | 10 | 41 |
| 2016 September | 28 | 3 | 31 |
| 2016 August | 34 | 4 | 38 |
| 2016 July | 10 | 2 | 12 |
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