[The surgical treatment of pancreatic cysts and pseudocysts]

Pancreatic cysts and pseudocysts are now being detected more often as a result of wide use of abdominal echography and CT scan. Surgical strategy advocates resection whenever possible for true cysts and internal drainage for pseudocysts. The present study retrospectively analyses 8 cases of true cysts and 23 cases of pseudocysts submitted to surgery in a twenty years period. Conservative treatment and ultrasonography-guided percutaneous drainage were not discussed. Four true cysts with positive benign structure were treated by internal drainage and only two adenocarcinomas were resected. In two more malignancies internal drainage was done as a palliative procedure followed by lethal outcome. Pseudocysts were secondary to acute pancreatitis in 7 cases, chronic pancreatitis in 6 cases, abdominal trauma in 4 cases and were idiopathic in 6 cases. Caudal pancreatectomy was performed whenever distal localisation was diagnosed. External drainage imposed in 5 emergency situations but internal drainage was elective in 13 cases. In conclusion according to our experience internal drainage should be preferred as the main surgical treatment in all mature pseudocysts and also when benign true cysts are certified. Posterior transgastric cystogastroanastomosis is the procedure of choice.