Laparoscopic Internal Drainage for Pediatric Pancreatic Pseudocysts
Authors: Xiong Xiangang , Qiu Ronglin , Su Jianhang , Chen Luping , Liao Minyi , Jin Shikai , Zhao Zhuangjie , Lu Zijie , Peng Junli , Yang Yi , Wu Yaohao , Deng Xiaogeng 
Published: March 2024

Abstract

Background:Pancreatic pseudocysts are rare in the pediatric population. Currently, internal drainage surgery is considered the ideal treatment for this disease. However, there have been few reports on laparoscopic pediatric pancreatic pseudocyst jejunal Roux-en-Y anastomosis surgery. Therefore, this study aimed to investigate the efficacy and safety of laparoscopic pancreatic pseudocyst jejunal Roux-en-Y anastomosis surgery in the treatment of pancreatic pseudocysts in children.Methods:A retrospective analysis was conducted on clinical data from three pediatric pancreatic pseudocyst cases admitted to the department of Pediatric Surgery of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from April 2021 to September 2023. All patients were received CT or MR scan to evaluate the location and size of the lesions. The dynamic changes in blood leukocyte analysis, serum amylase, and liver function were also checked before and after surgery. The inclusion criteria for surgical treatment were ineffective drug treatment, a cyst diameter greater than 6 cm, and patients with cysts present for more than 6 weeks. General clinical data, blood test results, surgical time, intraoperative blood loss, and postoperative complications were collected and statistically analyzed. All patients were followed up for 2-12 months, with an average follow-up time of 8.33 months.Results:There were 1 male and 2 female patients, aged between 7 and 14 years with an average age of 9.66 years. All patients had a body mass index (BMI) <15, classified as severely underweight. The diagnosis of pancreatic pseudocysts was made based on clinical manifestations, hematological test results, and CT/MR imaging. Two patients underwent laparoscopic pancreatic pseudocyst jejunal Roux-en-Y anastomosis surgery, while one patient received drug therapy. The intraoperative blood loss for the two surgical patients was 20 ml each, with no blood transfusions required intraoperatively. On the 4th postoperative day, bowel movements resumed, and on the 5th postoperative day, oral intake resumed. The abdominal drainage tube was removed within 1 week postoperatively, and a CT scan performed 1 week after surgery showed a significant reduction in the size of the pancreatic pseudocyst with unobstructed internal drainage. No complications such as fever, bleeding, pancreatic leakage, intestinal leakage, anastomotic stenosis, intestinal obstruction, or fistula formation occurred postoperatively. Blood leukocyte count, serum amylase, and transaminase levels transiently increased on the 1st postoperative day and subsequently decreased to normal levels within 1 week, stabilizing within the normal range. The serum amylase levels gradually decreased to normal in the patient receiving drug therapy, with blood leukocyte count and transaminase levels remaining within the normal range. All patients recovered well, and no recurrence or progression of pancreatic pseudocysts was observed.Conclusion:Laparoscopic pancreatic pseudocyst jejunal Roux-en-Y anastomosis surgery is safe and effective in the treatment of pancreatic pseudocysts in children and deserves to be promoted.