EFFECT OF FAILED COMPUTED TOMOGRAPHY-GUIDED AND ENDOSCOPIC DRAINAGE ON PANCREATIC PSEUDOCYST MANAGEMENT

Background. Computed tomography and endoscopic drainage are used incre asingly to treat pancreatic pseudocysts (PP). We reviewed our experien ce with PP to compare the outcomes of patients operated on initially ( group 1) with those whose nonoperative treatment failed (computed tomo graphy-guided or endoscopic drainage) before operation (group 2). Meth ods. The records of 70 consecutive patients operated on for PP were re viewed. The 52 patients (74%) in group 1 and 18 (26%) in group 2 were compared in terms laboratory test results on examination and before op eration, operative findings, mortality, and recurrence rates. Results. Before the initial drainage attempt, mean serum amylase level was hig her in group 2 (542 +/- 25 vs 163 +/- 17 IU/L; p = 0.01). All other la boratory values were similar. Before operative drainage, group 2 patie nts had lower hemoglobin (10.7 +/- 0.5 vs 12.2 +/- 0.3 gm/dl; p < 0.05 ) and serum albumin level (2.7 +/- 0.2 vs 3.5 +/- 0.1 mg/dl; p < 0.01) than group 1. Morbidity was twice as frequent in group 2 (33% vs 14%) . The time from initial attempt at drainage to PP resolution was longe r in group 2 (104 +/- 36 vs 20 +/- 4 days; p = 0.01). However, the tim e from operation to resolution was similar in both groups (21 +/- 8 vs 20 +/- 4 days). Conclusions. Failed nonoperative drainage is associat ed with a protracted illness and carries a risk of increased morbidity after operative intervention.