Operative treatment of pseudocysts in patients with chronic pancreatitis

Background: Pseudocysts associated with chronic pancreatitis are generally intrapancreatic and associated with parenchymal disease. They tend to persi st and cause complications. Minimally invasive methods of treatment challen ge the traditional techniques of operative management. Surgical operation a llows definitive treatment of the pseudocyst with the option of dealing app ropriately with the diseased pancreas and excluding a neoplastic process. T he aim of this study was to review the safety and efficacy of a surgical ap proach to the management of pseudocysts associated with chronic pancreatiti s. Methods: A. personal series of 112 consecutive patients operated for pseudo cysts in the setting of chronic pancreatitis was reviewed. Chronic pancreat itis was confirmed by imaging studies in association with exocrine and/or e ndocrine failure. Cysts were multiple in 31 patients and presented with com plications other than pain in 47. Data were collected prospectively regardi ng the clinical presentation, the nature of the operation and its outcome. Results: Forty-eight patients (43 per cent) underwent drainage procedures, 56 (50 per cent) had a resection and eight (7 per cent) had a combination. Larger cysts and those located in the head and neck tended to be drained, w hile smaller and distal cysts were more often resected, The morbidity rate was 28 per cent and the operative mortality rate was 1 per cent, The cyst r ecurrence rate was 3 per cent and pain was relieved in 74 per cent of patie nts, Conclusion: Operative management of pseudocysts associated with chronic pan creatitis is effective with low morbidity and mortality rates. The introduc tion of newer minimally invasive techniques will have to withstand comparis on to this traditional approach.