Pancreatic Pseudocysts: A Retrospective Comparative Study of Contemporary Management Strategies at a Tertiary Care Centre in Central India

Pancreatic pseudocysts are common sequelae of acute and chronic pancreatitis. In India, where alcohol-related and tropical pancreatitis are prevalent, management strategies vary across institutions based on available expertise and resources. The optimal treatment approach remains debated, particularly in centres without advanced endoscopic capabilities.

To compare clinical outcomes, complications, and hospital stay duration of conservative, percutaneous, and surgical management of pancreatic pseudocysts at a tertiary care centre in central India.

This retrospective observational study included 28 consecutive patients diagnosed with pancreatic pseudocysts between January 2024 and December 2025 at JK Hospital, Bhopal. Patients were grouped based on primary management: conservative (n=8), percutaneous drainage (n=13), or surgical cystogastrostomy (n=7). Primary outcomes included resolution rate, recurrence, complications, and hospital stay.

Mean patient age was 42.1 ± 13.2 years with male predominance (22, 78.6%). Alcohol consumption was the leading etiology (15, 53.6%), followed by idiopathic (seven, 25.0%) and gallstone-related pancreatitis (five, 17.9%). Conservative management achieved 75.0% resolution in selected asymptomatic patients with small pseudocysts (<6 cm). Percutaneous drainage showed initial success in 11 (84.6%) patients, but five (45.5%) had recurrence requiring surgical intervention. Surgical cystogastrostomy achieved definitive resolution in seven (100%) patients with no recurrences, median hospital stay of nine days, and one (14.3%) complication. No mortality was observed in any treatment group.

Management of pancreatic pseudocysts should be individualized based on cyst characteristics, symptoms, and available resources. Conservative treatment remains appropriate for asymptomatic patients with small immature pseudocysts. Percutaneous drainage provides temporary relief but has high recurrence rates. Surgical cystogastrostomy offers definitive treatment with excellent outcomes for symptomatic mature pseudocysts. In centers without advanced endoscopic capabilities, a stepwise approach from conservative to percutaneous to surgical management provides safe and effective outcomes.