MANAGEMENT OF PANCREATIC PSEUDOCYSTS

Background: Operative internal drainage has been standard treatment fo r chronic unresolved pancreatic pseudocysts (PPs). Recently, percutane ous external drainage (PED) has become the primary mode of treatment a t many medical centers. Study Design: A retrospective chart review was performed of 96 patients with PP's who were managed between 1987 and 1996. Longterm followup information was obtained by telephone anti mai l questionnaire. Results: Twenty-seven patients underwent computed tom ographic (CT)-guided PED. PP resolution occurred in 17 patients. Clini cal deterioration or secondary infection mandated urgent pancreatic de bridement in 7 (26%) patients and cystgastrostomy in 2 (7%) patients. There was one hospital death in this group. Thirty-two patients underw ent cystgastrostomy or cystjejunostomy (n = 21), distal pancreatectomy (n = 8), pancreatic debridement and external drainage (n = 2), or cys tectomy (n = 1). Two (6%) patients required postoperative pancreatic d ebridement for failure of resolution and peritonitis and two patients underwent PED of abscess. There was one hospital death in the expectan tly managed group of 37 patients. Median followup of 3 years (range, 0 .5-9.3 years) in 66 patients revealed that 6, 3, and 4 patients of PED , surgery, and expectantly managed groups, respectively, had radiologi c evidence of recurrent PPs. Conclusions: Operative management for PPs appears to be superior to CT-guided PED. Although the later was often successful, it required major salvage procedures in one third of the patients. An! expectant management protocol may be suitable for select ed patients. (C) 1998 by the American College of Surgeons.