Surgical approaches for pancreatic ascites: Report of three cases

Pancreatic ascites can occur in association with the rupture of a pseudocys t or the disruption of a pancreatic duct during the natural course of chron ic pancreatitis. We report herein the successful treatment of three patient s with pancreatic ascites by performing a surgical procedure after 4-6 week s of total parenteral nutrition (TPN) pro, ed ineffective. The principles o f our surgical procedure for pancreatic ascites are as follows: (1) minimum pancreatic tissue is resected; (2) surgical intervention to repair leaking sites is not necessary; (3) pancreatic duct drainage is facilitated by an intestinal ROUX-en-Y loop; (4) An external drainage tube is inserted throug h the Ronx-en-Y loop into the main pancreatic duct. All three patients who underwent our surgical procedure had a good outcome. Although the mean foll ow-up time is still only 18.3 months, their condition has improved, with no evidence of recurrent ascites, Thus, our surgical procedure should be cons idered as an appropriate treatment for pancreatic ascites because it can be applied for all types of leakage, including leakage from the posterior wal l of pancreas; it preserves pancreatic function, especially endocrine funct ion; and it enables preservation of the spleen.