Natural Course of Intra-abdominal Fluid Collections Following Minimally Invasive Left Sided Pancreatectomy

Sung Hwan Lee, MD, Chang Moo Kang, MD, Ho Kyoung Hwang, MD, Sung Hoon Choi, MD, Woo Jung Lee, MD. Department of Surgery, Yonsei University College of Medicine.

 Introduction
Intra-abdominal fluid collections (IFC) at operative bed were frequently founded after minimally invasive left sided pancreatectomy. However, natural course of IFC following minimally invasive left sided pancreatectomy have not been evaluated thoroughly yet.

Method
From July 2006 to May 2011, seventy-four patients underwent minimally invasive left sided pancreatectomy for benign or malignant pancreatic lesions by single surgeon. All patients were performed abdominal CT scan routinely after operation for identification of complications. If IFC were detected, the patient was followed up by CT scan regularly to complete resolution. We measured the size of IFC in axial and coronal view of abdominal CT scan each time.

Results
Among 74 patients underwent minimally invasive left sided pancreatectomy, IFC were developed in 70 patients (94.6%). IFC have resolved gradually in all cases except 5 cases lost of follow-up before complete resolution (median time: 27 weeks, range: 8–204 weeks). 67 patients were asymptomatic and 3 patients presenting symptom consistent with local peritonitis were performed intervention procedure (percutaneous catheter insertion, gastrocystostomy by endoscopy). In resolution analysis using Kaplan-Meier survival analysis, 50% of IFC were resolved within 27 weeks after operation. Malignant pancreatic lesion showed significantly shorter resolution time than benign in sub-group analysis (p=0.005).

Conclusions
IFC at operative bed were developed in most of cases following minimally invasive left sided pancreatectomy. Most of IFC were asymptomatic and disappeared spontaneously without intervention.

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