Abstract
Background: Until now no consensus has been reached on surgical approach to pancreatic pseudocysts and fistulas in children who suffered from acute pancreatitis (AP). Objective: To present our surgical tactics used to treat children with AP complicated by external pancreatic fistulas (EPF) and pseudocysts (PPC) in the Department of Pediatric Surgery of MONIKI. Materials and methods: Our retrospective research included 129 cases of AP in children (aged from 6 months to 17 years) who received treatment in the Department of Pediatric Surgery of MONIKI named after M.F. Vladsimirskiy from 1990 till 2014. Research data included age, sex, symptoms, blood levels of amylase and lipase, treatment procedure, hospital stay, PPC or EPF and treatment outcomes. Results: 80 (62%) children had mild pancreatitis, 8 (6%) - moderate and 41 (32%) suffered from severe disease. PPCs and EPFs were observed in 22 (17%) patients with destructive pancreatitis. Mean hospital stay made 31,3±15 days. 12 (9,3%) children had PPC, 7 (5,4%) patients had EPF and in 3 (2,3%) children the combination of both complications was observed. All patients with EPF received complex conservative treatment with its outcomes of total EPF repair without surgery in all cases within the period from 1 to 3-4 months. 7 children with PPC less than 5 cm in diameter and no communication between PPC and pancreatic duct received conservative treatment. In cases of PPC more than 5 cm in diameter and no communication to pancreatic duct our surgery options included percutaneous US-guided punctures. Endoscopic drainage was performed in 2 children with chronic large PPC located near head and body of pancreas and with communication to pancreatic duct. Conclusion: In cases of AP with EPF in children we recommend active conservative treatment for 3 months since fistula manifestation. The choice of either surgery or conservative treatment is to be determined by PPC size and location, how long it persists and whether there is a communication between PPC and pancreatic duct, the effect of therapy is also to be counted.
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