Multiple pancreatic pseudocysts: the principle of internal cystocystostomy in surgical management

Multiple pseudocysts exist in 5% to 10% of all patients with pancreatic pseudocysts. No procedural recommendations have been previously offered for the elective treatment of coexisting mature pseudocysts. In 10 patients with large (greater than 5 cm in diameter) adjacent pseudocysts, a segment of the common wall was removed (internal cystocystostomy) to create a common chamber, which was then drained by an appropriate cystogastrostomy or cystojejunostomy Roux-en-Y. No recurrences have been observed during an average follow-up of almost 2 years. In each of two patients with two large pseudocysts that were not contiguous, both pseudocysts were drained into a single Roux-en-Y limb (double cystojejunostomy Roux-en-Y). Operative cystography was performed on all small pseudocysts (less than 5 cm in diameter). Simple operative aspiration was employed on five occasions when the small pseudocyst did not communicate with the pancreatic duct. The principle of internal cystocystostomy combined with internal drainage appears useful in the management of large contiguous pseudocysts. For noncontiguous large pseudocysts, multiple cystojejunostomy deserves wider trial, as does operative aspiration of small pseudocysts demonstrated not to be in continuity with the pancreatic ducts.