Management of Pancreatic Pseudocysts

Shim, Hee Soo; Yoon, Dong Sup; Chi, Hoon Sang

Abstract

A pancreatic pseudocyst is the most common cystic lesion in the pancreas encountered in the clinical practice. The management of pancreatic pseudocyst is a complex and prolonged problem for the general surgeon. Especially, considerable ambiguity exists regarding both the incidence for surgery and the timing of operative intervention in patients with pancreatic pseudocysts. The clinical courses of 50 patients with pancreatic pseudocysts were retrospectively reviewed in the Department of Surgery at Young Dong Severance Hospital during the period of 10 years from March 1985 to February 1995. The results were as follows: 1) The pancreatic pseudocysts were most prevalent in the 3rd and the 4th decade (58%) of age, and the male to female ratio was 3.5:1. 2) Alcoholic pancreatitis was the disease most frequently associated with pancreatic pseudocysts (44%). 3) The frequent symptoms or signs of patients of pancreatic pseudocyst were abdominal pain (84%), abdominal masses (24%), and nausea and vomiting (20%). 4) Valuable diagnostic radiologic methods were abdominal sonography (82%), abdominal CT (96%), and ERCP (80%). 5) The applied surgical methods were Roux-en-Y cystojejunostomy (37% of all surgical cases), pseudocyst resection or distal pancreatectomy (50%), and external drainage (13%).Surgical indications for the conservative management group were persistent symptoms and/ or increase in size in eleven patients (33%) and natural complications in six patients (18%). As the size of the pseudocyst increase, resolution rate tended to decrease and the complication rate tended to increase, but complete resolution occurred in 26% of the pseudocysts sized from 5 cm to 10 cm. Two pseudocysts greater than 10 cm in size were treated successfully with conservative management. We conclude that the cyst size and the cyst age are not absolute criteria for determining surgical indications.