Surgical treatment of pancreatic pseudocysts [Trattamento chirurgico delle pseudocisti del pancreas.]

The Authors report their experience of 62 consecutive patients with pancreatic pseudocysts observed within the period 1973-1993. Spontaneous resolution of the pseudocyst occurred in 16 cases. Forty-five patients were surgically treated (31 post-necrotic cysts, 5 post-traumatic cysts and 9 retention cysts); operations included internal drainage in 32 (cystojejunostomy in 13, cystogastrostomy in 18 and cystoduodenostomy in one), external drainage in 8 and pancreatic resection in 5 patients. One patient underwent percutaneous catheter drainage of a post-necrotic pseudocyst. Indications for surgery included complications, nonresolution or persistence of symptoms, and extension. The operative mortality and morbidity rates were higher in the patients submitted to external drainage (22.2% vs 6.2%; 55.5% vs 21.8% respectively). On the basis of the results the Authors conclude that the internal drainage, particularly cystojejunostomy, should be considered the operation of choice for pancreatic pseudocysts because of the lower mortality and morbidity. On the contrary, external drainage is indicated for infected or ruptured pseudocysts.