The treatment of pancreatic pseudocysts by external drainage.

Twenty-two patients were treated for 25 occurrences of pancreatic pseudocysts. The male to female ratio was 3:1, and the average age was 39 years. Alcoholism was the most common cause of the preceding episode of pancreatitis. The pseudocyst rarely developed from end-stage chronic pancreatitis. Our preferred treatment for the majority of pancreatic pseudocysts is external sump drainage, if there is no obstruction of the distal part of the pancreatic duct. This form of treatment was followed by a 100 per cent survival rate, and neither a pancreaticocutaneous fistula nor a pancreatic abscess occurred. The two instances of a recurrence were due to our treatment with a Penrose drain alone, and this practice is not recommended. Obstruction of the distal part of the pancreatic duct negates external sump drainage, and in such instances, a Roux-en-Y cystojejunostomy should be the treatment of choice and not transgastric cystogastrostomy, which does not offer dependent drainage. The treatment of a pancreatic pseudocyst should not be equated with that of chronic fibrotic pancreatitis, as the basic pathologic clinical features and response to surgical treatment are quite different.