When drained out
The pseudocyst after acute pancreatitis forms a dense wall only by the 6th week; Before this period, in case of suppuration, rupture or compression of organs, external drainage is safe: the contents (pancreatic juice, detritus) are drained, the cavity is washed, and the inflammation subsides. Drainage remains from 2 to 6 weeks under the control of ultrasound and amylase of the discharge; In some patients, the cyst closes completely; if the connection with the duct is maintained, internal drainage is performed after 2–3 months (cystogastro-/cystojejunostomy). The contents are examined for amylase, cytology, and culture.
Indications
- simple (non-parasitic) liver cysts larger than 5–7 cm or with symptoms;
- spleen cysts with risk of rupture;
- pancreatic pseudocysts after pancreatitis - mature, more than 6 cm, with pain, compression;
- suppuration of cysts, rapid growth, doubts about character (after excluding echinococcus).
Tactics for cysts
Simple liver cysts are treated with laparoscopic fenestration: wide excision of the dome of the cyst with treatment of the lining - relapses are rare, the organ is preserved. Pancreatic pseudocysts associated with the duct drain externally (with an immature wall and suppuration) or internally into the stomach/intestine (mature). Before surgery, a parasitic nature (serology for echinococcus) and a tumor (MSCT/MRI, tumor markers for pancreatic cysts) must be excluded. All walls and contents are examined histologically and cytologically.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
