The surgical treatment of pancreatic pseudocysts. Personal experience

This study is aimed at contributing to defining a correct therapeutic management of pancreatic pseudocysts (PPCs): indications for treatment, operative timing and technical approach.

A retrospective analysis of 28 patients affected by PPC, 22 males (78.5%) and 6 females (21.5%), with a mean age of 52 years (range 17-76) has been performed. The diagnosis was realised by clinical assessment and US (ultrasonography) or CT (computerized tomography) scanning. The treatment consisted in surgical drainage (internal or external) or percutaneous drainage with US guidance: the cystojejunostomy with a Roux-en-Y loop was the first choice technique.

Twenty-two patients (78.5%) under-went a surgical procedure: 19 cystojejunostomies with a Roux-en-Y loop and 3 external drainages. The mean interval between acute pancreatic event and elective surgery was 9 weeks (range 5-21). Perioperative morbidity and mortality was respectively 22.7% (5/22) and 13.6% (3/22). In 4 cases a percutaneous drainage with US-guidance, without morbidity and mortality was performed, but 2 patients required a successive surgical operation for lack of resolution of the PPC. The last 2 patients of this series recovered spontaneously.

Currently the cystojejunostomy with a Roux-en-Y loop remains the first choice technique for an elective and definitive treatment of PPCs: other techniques (endoscopic internal drainage, surgical or percutaneous external drainage) should be limited to complicated PPCs or to high surgical risk patients. A waiting period of 4-6 weeks following the acute pancreatic event is considered the minimal time necessary before the elective treatment.