Presentation of pancreatic pseudocysts: implications for timing of surgical intervention

A review of 115 patients with pancreatic pseudocysts treated surgically between 1976 and 1984 showed four patterns of presentation: pseudocyst alone, pseudocyst and acute pancreatitis, acute pancreatitis alone, or neither apparent on hospital admission. These patterns of presentation were associated with differences in the clinical course and ultimate surgical outcome of each group of patients. Emergency procedures greatly increased the morbidity and mortality of surgery for pseudocysts. A preoperative delay for pseudocyst maturation was expected to decrease the morbidity and mortality of elective pseudocyst drainage, but no benefit was found either for the series as a whole or for any subgroup. We conclude that an arbitrary preoperative delay for pseudocyst maturation (in the absence of acute pancreatitis) exposes patients to the risks of preoperative complications, increases the expense of care for pancreatic pseudocysts, and fails to improve surgical outcome.