Endoscopic Options for Complications after Pancreatic Surgery.

BACKGROUND

The shift in surgery is taking place in two directions. On the one hand, it is shifting from open surgery to minimally invasive surgery which will ultimately morph into robot-assisted surgery. On the other hand, the therapeutic possibilities of flexible endoscopy have developed enormously in recent years. Various procedures, such as the debridement of pancreatic necrosis, the resection of early neoplasms, the treatment of achalasia, or the resection of numerous submucosal tumors, have passed into the hands of the interventional endoscopist. Endoscopic procedures have also become established in the management of complications of major intestinal procedures. Despite the fact that endoscopic therapy requires time to heal, for example, in VAC therapy, it being less invasive reduces patient morbidity.

SUMMARY

The most common complications in modern pancreatic surgery are pancreatogenic fistulas and fluid collections, as well as insufficiencies of pancreatointestinal or biliodigestive anastomoses. Such complications can be treated endoscopically using methods such as stent placement in the pancreatic or bile duct, endosonographically guided drainage of fluid collections, and even VAC therapy.

KEY MESSAGES

Endoscopic intervention is the first procedure of choice offered in the treatment of complications in pancreatic surgery. It primarily reduces morbidity in the recovery phase of patients.