Surgical treatment of pseudocysts of the pancreas--guidelines for management

From 1968 to 1983 123 patients were admitted with a diagnosis of pancreatitis; in 28 patients a pseudocyst developed. To evaluate results of surgical therapy a study of the literature and a chart review were performed. From this study we conclude that asymptomatic patients with a pseudocyst of 4 cm or less in diameter can initially be treated expectantly. If the pseudocyst is larger than 4 cm in diameter and in those cases where the cyst shows no tendency to spontaneous resolution, operative intervention seems mandatory. If no complications occur, surgery is postponed until six weeks' observation to allow maturation of the cyst and facilitate cystenteric anastomosis. In pseudocysts related to blunt abdominal trauma, endoscopic retrograde cholangiopancreatography (ERCP) should be performed. If ERCP reveals a major duct lesion, resection should be considered.