Title: Study of Surgical Complications of Pancreatitis
Authors: Dr Pravin Bhingare, Dr Ninad Sawant
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.157
Abstract
Aims and Objectives: (1) Study of patients of pancreatitis with respect to their complications requiring surgical intervention. (2) To study prognosis of patients after surgical treatment of complications of pancreatitis.
Study Design:- This was a descriptive study carried out in a tertiary care centre over a period of 18 months and included patients of acute and chronic pancreatitis with their surgical complications.
Materials and Methods:- The study was approved by the Institutional ethical committee and included patients of acute and chronic pancreatitis with their surgical complications. Patients were included in this study only after being diagnosed as a complication of pancreatitis needing surgical intervention. Informed consent was obtained after explaining all patients regarding disease outcome and possible complications related to surgical treatment. Patients having history of trauma, those who denied consent, those in whom regular follow up was not possible and those who didn't give consent were excluded from the study.
Results: The study of surgical complications of pancreatitis revealed that the peak incidence of their occurrence was in between age group of 30 to 39 years (29.54%) followed by in the age group of 40-49 years (15.90%). Predominantly males were affected with a male to female ratio being 1: 0.12. The most common etiology was found to be alcohol (68.18%) followed by idiopathic (15.90%) and malnutrition (11.36%). The most common presenting complaints were pain (90.90%) followed by weight loss (86.36%) and steatorrhoea (43.18%). On clinical examination the most common physical finding was tachycardia (29.54%), icterus (20.45%) and raised temperature (18.18%). Blood investigations most common abnormalities found were anemia, leucocytosis, hyperbillirubinemia, and increased serum lipase levels. On X-ray Pleural effusion and abdominal calcifications was found in 13 (29.54) and 12 (27.27%) patients respectively. The most common surgical complication in studied cases were pseudocyst formation (36.36%), ductal dilatation with without ductal calculi (25%) and pancreaticopleural effusion (15.90%). Uncomplicated pseudocyst (31.81%), pancreatic calcification (27.27%),pancreatic ductal calculi (20.45%), atrophy of pancreas (20.45%) and CBD dilation (20.45%) were the most common imaging abnormalities seen in CT and MRCP. Obstructive jaundice was seen in 9 (20.45%) patients. The most common surgical procedure done in studied cases was intercostal drain insertion for pleural effusion which was done in 7 (15.90%) other common surgical procedures were laparoscopic cystogastrostomy (4.54%), and laparoscopic LPJ (9.09%). Laparoscopic surgeries were done in 16 (36.36%) cases while open surgeries were done in 28 (63.63%) patients. Immediate post-operative complications included wound infection (9.09%), bleeding (4.54%) and anastomotic leak (4.54%). Common late post-operative complications were Deranged blood sugar levels (11.36%), intra-abdominal abcess (6.81%) and weight loss (6.81%). Amongst the patients operated for pancreatic pseudocyst only 1 patient presented with pseudocyst recurrence 6 months after initial surgery. Puestow procedure was most commonly associated with weight gain. All 6 (100%) patients had weight gain after this procedure while necrosectomy was least associated (20%) with weight gain. The most effective procedure in terms of pain relief was puestow procedure in which 6 (85.71%) out of 7 patient had pain relief. The overall mortality in the study was found to be 6.81%.
Keywords: Pancreatitis, Surgical complications, prognosis, disease outcome.
