Primary Early Surgical Management of Pancreatic Ascites Complicating Chronic Pancreatitis-A Single Centre Experience

Abstract

Introduction: The traditional method of managing Pancreatic Ascites (PA) complicating Chronic Pancreatitis (CP) was with initial conservative treatment which was associated with increased morbidity and mortality. Aim: To describe about the new treatment protocol which lays emphasis on primary early surgical intervention for PA complicating advanced CP cases based on the pathological morphology of the disease instead of an initial trial of conservative treatment. Materials and Methods: This was a prospective observational study of 15 cases of CP with PA managed over a three year period. The approach was guided by the pathological morphology defined by a CECT abdomen and/or Magnetic Resonance Cholangiopancreatography (MRCP). Of the observed 15 cases, imaging showed a dilated Main Pancreatic Duct (MPD) 5-10 mm in 11 cases, ductal disruption in 4/11 cases and pseudocyst in 8/11 cases. These 11 cases underwent primary early direct surgery. Surgery was tailored to the individual case with a combination of internal ductal/pseudocyst drainage and/or distal resection. Resolution of PA and relief of symptoms were the primary outcome measures. Recurrence of PA at one year follow up after surgery was the secondary outcome measure. Results: Resolution of PA and relief of symptoms occurred in all patients in the primary surgery group. The mean duration of hospital stay was 16 days in the primary surgery group with a range of nine to 23 days with no mortality and no disease recurrence after one year of follow up. Conclusion: Primary early direct surgery guided by the MPD morphology (duct diameter >5 mm) in selected patients with CP and PA leads to faster recovery of the patient and it takes care of the primary pathology too.

Keywords

• fistula
• internal pancreatic fistula
• pancreatic duct disruption
• pseudocyst