Minimally invasive surgical treatment of pancreatic cysts

BACKGROUND: Numerous surgical treatment options for pancreatic cysts are currently available, including open and minimally invasive surgeries. The latter include endoscopic and percutaneous puncture techniques. The primary challenge is selecting the most effective approach.

AIM: This study aimed to examine the possibilities of modern ultrasound-guided minimally invasive surgical treatment options for pancreatic cysts and determine the most promising approaches.

METHODS: The study included 264 patients, who were divided into two groups. Group 1 (n = 168) included patients after ultrasound-guided percutaneous puncture drainage. Group 2 (n = 96) included patient after endoscopic transmural drainage. Therapeutic indications included cyst size over 5 cm, abscess formation, and compression of neighboring organs.

RESULTS: In Group 1, favorable outcomes were reported in 75% of patients. During follow-up, 25% of patients had recurring cysts. No recurring cysts were reported in patients after endoscopic drainage. Long-term treatment outcomes were assessed in 120 patients, with 80 after percutaneous drainage and 30 after endoscopic drainage.

CONCLUSION: Percutaneous drainage was effective in 75% of patients. The reported high recurrence rate was associated with inadequate obliteration of the cyst cavity connected with the pancreatic duct. Endoscopic stenting provides permanent cyst decompression by creating an artificial anastomosis between the cyst cavity and the gastric lumen. This technique reduces pancreatic hypertension, and its clinical efficacy correlates with two critical factors: the duration of stent functioning and the ability to form a stable fistular tract.