Operative treatment of pseudocysts in patients with chronic pancreatitis.

BACKGROUND: Pseudocysts associated with chronic pancreatitis are generally intrapancreatic and associated with parenchymal disease. They tend to persist and cause complications. Minimally invasive methods of treatment challenge the traditional techniques of operative management. Surgical operation allows definitive treatment of the pseudocyst with the option of dealing appropriately with the diseased pancreas and excluding a neoplastic process. The aim of this study was to review the safety and efficacy of a surgical approach to the management of pseudocysts associated with chronic pancreatitis.

METHODS: A personal series of 112 consecutive patients operated for pseudocysts in the setting of chronic pancreatitis was reviewed. Chronic pancreatitis was confirmed by imaging studies in association with exocrine and/or endocrine failure. Cysts were multiple in 31 patients and presented with complications other than pain in 47. Data were collected prospectively regarding the clinical presentation, the nature of the operation and its outcome.

RESULTS: Forty-eight patients (43 per cent) underwent drainage procedures, 56 (50 per cent) had a resection and eight (7 per cent) had a combination. Larger cysts and those located in the head and neck tended to be drained, while smaller and distal cysts were more often resected. The morbidity rate was 28 per cent and the operative mortality rate was 1 per cent. The cyst recurrence rate was 3 per cent and pain was relieved in 74 per cent of patients.

CONCLUSION: Operative management of pseudocysts associated with chronic pancreatitis is effective with low morbidity and mortality rates. The introduction of newer minimally invasive techniques will have to withstand comparison to this traditional approach.