Thakur Mohim, Dhiman Ajay K
General Surgery, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND.
Cureus. 2023 Feb 6;15(2):e34694. doi: 10.7759/cureus.34694. eCollection 2023 Feb.
Pancreatic pseudocyst (PPC) and walled-off necrosis (WON) develop as late complications of acute pancreatitis that have been historically managed surgically. With the advancement in endoscopic equipment and the evolution of endoscopic surgery, the management of PPC has evolved considerably in recent years from surgical drainage to transmural endoscopic drainage. Till the end of the 20th century, a limited number of surgeons performed laparoscopic drainage of PPCs. Due to the steep learning curve needed for performing advanced laparoscopic suturing, a majority of studies conducted during this period have compared open surgical drainage with endoscopy. The efficacy of these modalities has largely been evaluated using retrospective studies and a few meta-analyses particularly due to the low-volume caseload of individual centres. Also, these studies include PPC and WON together in data analysis despite WON being a distinct entity. There are limited prospective well-designed clinical trials comparing endoscopic and laparoscopic management of pure PPCs. There is also a lack of specific recommendations for the management of PPCs. Considerable overlap of indications between these two modalities exists. The efficacy of endoscopic transmural drainage as an index intervention when compared to laparoscopy has not been proven in the research literature. Previous studies have not considered multiple endoscopic interventions within a four-week period of index intervention as a failure. We reviewed the literature using appropriate MeSH terms on the PubMed search engine for articles comparing laparoscopic and endoscopic transmural management of PPCs according to our inclusion and exclusion criteria. Seven articles were identified for inclusion in the qualitative synthesis. This scoping review was conducted to answer some pertinent unanswered questions, identify gaps in knowledge regarding the laparoscopic vs endoscopic management of PPCs, and guide further research.
胰腺假性囊肿（PPC）和包裹性坏死（WON）是急性胰腺炎的晚期并发症，过去一直通过手术治疗。随着内镜设备的进步和内镜手术的发展，近年来PPC的治疗方法已从手术引流大幅演变为经壁内镜引流。直到20世纪末，只有少数外科医生进行腹腔镜下PPC引流。由于进行高级腹腔镜缝合所需的学习曲线较陡，这一时期进行的大多数研究都将开放手术引流与内镜检查进行了比较。这些治疗方式的疗效主要通过回顾性研究和一些荟萃分析进行评估，特别是由于各个中心的病例数量较少。此外，尽管WON是一个不同的实体，但这些研究在数据分析中将PPC和WON放在一起。比较单纯PPC内镜和腹腔镜治疗的前瞻性设计良好的临床试验有限。对于PPC的治疗也缺乏具体建议。这两种治疗方式的适应症存在相当大的重叠。与腹腔镜检查相比，内镜经壁引流作为一种指标干预的疗效在研究文献中尚未得到证实。以前的研究没有将指标干预四周内的多次内镜干预视为失败。我们在PubMed搜索引擎上使用适当的医学主题词（MeSH）检索文献，以查找根据我们的纳入和排除标准比较PPC腹腔镜和内镜经壁治疗的文章。共确定了7篇文章纳入定性综合分析。进行这项范围审查是为了回答一些相关的未解决问题，找出关于PPC腹腔镜与内镜治疗的知识空白，并指导进一步的研究。
