Endoscopic Drainage of Pancreatic Pseudocysts

Pancreatic pseudocysts arise as a complication of acute and chronic pancreatitis, pancreatic trauma, or after surgery. Endoscopic treatment of pancreatic pseudocysts can be achieved using transpapillary and/or transmural (transgastric or transduodenal) approaches with acceptable success rates, complication rates, and recurrence rates. Advantages of endoscopic drainage is the avoidance of external pancreatic fistula.     

Endoscopic transpapillary stenting of pancreatic duct disruption

BACKGROUND/AIMS: Endoscopic transpapillary stenting of the pancreatic duct is increasingly being used in the management of pancreatic duct disruption. In contrast to its more established role in pancreatic duct obstruction, little is reported on the spectrum of indications and outcome in management of pancreatic duct disruption. METHODS: The indication for and outcome of transpapillary pancreatic duct stenting was analysed retrospectively in a UK supra-regional specialist pancreatobiliary centre, between January 1998 and August 2004. RESULTS: Data were obtained on 30 patients (19 male, 11 female, median age 53 years). The main indications for pancreatic duct stenting were: pancreatic pseudocyst, pancreatic ascites, pancreatic duct leak following necrosectomy, and pancreaticopleural fistula. The median duration of stenting was 6 weeks for fistulae and 10 weeks for pseudocysts. Twenty-one patients (70%) had complete resolution. After a median follow-up of 45 months, no recurrence was noted in successfully treated patents. CONCLUSION: Endoscopic transpapillary pancreatic duct stenting is an increasingly valuable treatment option in the management of pancreatic fistulae and pseudocysts.     

Management of pancreatic pseudocysts

BACKGROUND: This review analyses the outcome for patients with acute and chronic pancreatic pseudocysts managed in two major referral centres. PATIENTS AND METHODS: From 1987 to 1997, 33 patients were treated with either acute (n = 19) or chronic (n = 14) pseudocysts. Procedures performed included cystgastrostomy (64%), cystduodenostomy (6%), cystjejunostomy (3%), distal pancreatectomy with resection of pseudocyst (12%), laparotomy with external drainage (9%), endoscopic transpapillary stenting (3%) and endoscopic pancreatic duct sphincterotomy with percutaneous drainage of the pseudocyst (3%). RESULTS: All patients had resolution of their pseudocyst and no patient developed recurrence. There were no deaths in this series. There was a 9% incidence of major complications and a 21% incidence of minor complications. Outcome was excellent in 63% and good in 27% of patients. Two patients (6%) had persistent chronic pain and one patient (3%) had evidence of exocrine pancreatic insufficiency with malabsorption. CONCLUSIONS: Surgical internal drainage of pancreatic pseudocysts can be performed safely with low morbidity and mortality provided patients are carefully selected and their medical management is optimized. Although minimally invasive techniques now offer a variety of treatment options, open surgical drainage is still indicated for a significant number of cases.     

Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature

Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search words pancreatic and pseudocysts and all relevant articles in English Language or with English abstracts were retrieved. In addition, cross-references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.     

Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial

Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of PFCs but have not been compared in a randomized trial. Our objective was to compare endoscopic and laparoscopic internal drainage of pseudocyst/walled-off necrosis following AP. Patients with symptomatic pseudocysts or walled-off necrosis suitable for laparoscopic and endoscopic transmural internal drainage were randomized to either modality in a randomized controlled trial. Endoscopic drainage comprised of per-oral transluminal cystogastrostomy. Additionally, endoscopic lavage and necrosectomy were done following a step-up approach for infected collections. Surgical laparoscopic cystogastrostomy was done for drainage, lavage, and necrosectomy. Primary outcome was resolution of PFCs by the intended modality and secondary outcome was complications. Sixty patients were randomized, 30 each to laparoscopic and endoscopic drainage. Both groups were comparable for baseline characteristics. The initial success rate was 83.3% in the laparoscopic and 76.6% in the endoscopic group (p = 0.7) after the index intervention. The overall success rate of 93.3% (28/30) and 90% (27/30) in the laparoscopic and endoscopic groups respectively was also similar (p = 1.0). Two patients in the laparoscopic group required endoscopic cystogastrostomy for persistent collections. Similarly, two patients in the endoscopic group required laparoscopic drainage. Postoperative complications were comparable between the groups except for higher post-procedure infection in the endoscopic group (19 vs. 9; p = 0.01) requiring endoscopic re-intervention. Endoscopic and laparoscopic techniques have similar efficacy for internal drainage of suitable pancreatic fluid collections with < 30% debris. The choice of procedure should depend on available expertise and patient preference.     

Endoscopic management of pancreatic pseudocysts

This article reviews the history of and the authors' experience with endoscopic management of pancreatic pseudocysts. Discussion includes pseudocyst enterostomy and results, the transpapillary method, complications, endoscopic versus surgical and percutaneous therapy, and drainage of infected pseudocysts and pancreatic necrosis.     

超声内镜引导下穿刺引流治疗胰腺假性囊肿

目的探讨超声内镜引导下经胃肠壁穿刺置管引流治疗胰腺假性囊肿的疗效及并发症。方法选择2004年8月至2011年3月胰腺假性囊肿患者28例,首先使用线阵型超声内镜扫查,明确病变部位后选择合适穿刺点,导丝沿穿刺针道进入囊肿,沿导丝放置双猪尾硅胶支架1～3支。术后定期随访,囊肿消失后拔除支架。结果本组28例患者,穿刺引流成功25例,成功率为89．3％,其中经胃19例,经十二指肠6例。发生并发症3例,支架移位、出血、感染各1例。随访8—34个月,19例假性囊肿完全消失,6例腹痛症状消失、囊肿明显缩小、但持续存在2年以上,所有患者均未见假性囊肿复发。结论超声内镜引导下经胃肠壁穿刺置管引流术是治疗胰腺假性囊肿的较好方法之一,其疗效确切,并发症少。     

Endoscopic pancreatic duct drainage and stenting for acute pancreatitis and pancreatic cyst and abscess

Background/Purpose Endoscopic drainage of pancreatic pseudocysts using transpapillary and transmural approaches has been reported. In this study, endoscopic nasopancreatic drainage (ENPD) and pancreatic stenting were performed in patients with pseudocyst and abscess associated with acute pancreatitis, and the usefulness and problems of the procedures were investigated. Methods After endoscopic retrograde pancreatography was done, ENPD and/or pancreatic stenting were performed in 13 patients with pancreatitis and pseudocyst or abscess that communicated with the main pancreatic duct. Results ENPD was performed in seven patients, and was effective in all five patients with cysts: the cysts disappeared or shrank. However, the condition in the two patients with abscess was unchanged, and percutaneous drainage was performed. Stenting was carried out in six patients, and the cyst disappeared or pancreatitis was improved in all six. The stent was removed from two patients, but no recurrence has been noted so far. Conclusions ENPD and stenting are effective therapeutic choices for acute and chronic pancreatitis and pseudocysts, and they are superior to percutaneous drainage to avoid pancreatic fistula, but they may not be effective for pancreatic abscess. Selection of therapeutic methods corresponding to individual cases is important.     

���ټ��������ھ�����ǻ�����廯����68������

??Endoscopic??laparoscopic individualized treatment for pancreatic pseudocysts: An analysis of 68 cases YUAN Hai-cheng??QIN Ming-fang??WU Yu??et al. Minimally Invasive Surgery Center, Tianjin Nankai Hospital??Tianjin 300100??China
Corresponding author??YUAN Hai-cheng??E-mail??ironyhc2002@Gmail.com
Abstract Objective To investigate endoscopic??laparoscopic individualized treatment strategies for pancreatic pseudocysts based on the guidance of endoscopic??laparoscopic treatment program of pancreatic pseudocysts. Methods The clinical data of 68 cases of pancreatic pseudocysts treated in accordance with endoscopic??laparoscopic treatment program of pancreatic pseudocysts between March 2000 and December 2010 in Tanjin Minimally Invasive Surgery Center were analyzed retrospectively. The data included the general information??treatment methods, success rate??recurrence rate and complications. Results There were 28 cases of EUS-guided through the stomach cyst drainage??12 cases of laparoscopic cyst-gastric anastomosis??5 cases of laparoscopic cyst-jejunal Roux-en-Y anastomosis??23 cases of ERPD (5Fr pancreatic duct stent placed by endoscopy). Three cases had fever after EUS internal drainage. One case had peritonitis. There was no complication in other forms of treatment. Follow-up was last from six months to nine years in 82% (56/68) of cases without recurrence. Conclusion The endoscopic??laparoscopic treatment for pancreatic pseudocyst is more minimally invasive??can become individualized treatment strategies.     

Natural orifice translumenal endoscopic drainage for pancreatic abscesses

Background  Few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis, peritonitis, or both. This report describes the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. Methods  This study reviewed 35 consecutively treated patients for the period 1994–2007. The approaches alone or in combination were transmural (transgastric or transduodenal) and transpapillary. The criteria for abscesses were two or more of the following: fever, abdominal pain, elevated white blood count (WBC), and positive fluid cultures. Results  The 35 patients (19 men and 16 women) had a mean age of 49 years. The abscesses had idiopathic (37%), gallstone (32%), alcohol (20%), and divisum (11%) etiologies. The presenting signs were abdominal pain (80%), positive cultures (69%), fever (57%), elevated WBC (51%), and nausea/vomiting (39%). The approaches for abscess drainage were as follows: transgastric (n = 15, 43%), transduodenal (n = 4, 11%), transgastric combined with transpapillary (n = 8, 23%), transduodenal combined with transpapillary (n = 1, 3%), and transpapillary alone (n = 7, 20%). A total of 28 patients (80%) achieved successful endoscopic pancreatic abscess drainage, whereas 7 (20%) required surgery. Of these seven patients, two (6%) required emergent laparotomy to control bleeding, and the remaining five (14%) were explored after failure to demonstrate clinical improvement from endoscopic drainage. Three patients required internal drainage, and two patients required distal pancreatectomy. The mean follow-up period was 15 months, and the complication rate was 6%. No one died from the procedure. Conclusion  Endoscopic surgery for pancreatic abscess is feasible and effective. It is an alternative to surgery that currently can be considered a primary treatment option for selected pancreatic abscesses.     

Endoscopic drainage of pancreatic pseudocysts

Summary Seventeen patients with pancreatic pseudocysts were treated by endoscopic drainage. In nine cases we performed endoscopic retrograde pancreatic drainage (ERPD) by inserting 7-Fr pigtail catheters via the papilla into the cyst or into the main pancreatic duct. In two cases transduodenal cystotomy (ECD) and in eight cases transgastral cystotomy (ECG) are performed by using coagulator and papillotome. In five cases of ECG an endoprosthesis was inserted into the cyst. In two cases combination therapy of ERPD and ECG was performed. All patients reported reduction of continuous pain and postprandial epigastralgia after placement of endoprosthesis. After disappearance of symptoms and abnormal endoscopic findings within a period of 2–12 months the drainage tubes were removed. In one case postoperative dislocation of the prosthesis was observed; no serious complication was not encountered. The period of observation varied from 5 to 40 months. Two patients are presently under treatment with endoprostheses. Endoscopic drainage yielded good results in the treatment of pancreatic pseudocysts.     

Endoscopic drainage of pancreatic pseudocysts in children

Background/Purpose

Symptomatic pancreatic pseudocysts have traditionally been managed with surgical, percutaneous, and, more recently, endoscopic drainage. Although the role of the latter is well defined in the adult population, its utility in children needs to be clarified. The authors reviewed their experience with endoscopic drainage of pancreatic pseudocyst (EDPP).

Methods

A retrospective chart review was conducted, and relevant demographic and clinical data were obtained for all patients with pancreatic pseudocysts managed with endoscopic drainage in the period from 1997 through 2001, inclusive.

Results

Three children had successful endoscopic drainage of pancreatic pseudocysts. They were 9, 13, and 14 years old, and were all boys. The etiology of the pancreatitis was idiopathic related to anomalous pancreatic divisum ducts in the first 2 and azathioprine induced in the latter. The first 2 patients had endoscopic transpapillary drainage, whereas the third had an endoscopic cystduodenostomy. All patients had complete resolution of the pseudocyst clinically and radiologically after follow-up periods of 3, 31, and 21 months, respectively. The first needed a subsequent pancreaticojejunostomy for persistent symptoms related to chronic pancreatitis. A successful endoscopic drainage of a posttraumatic pancreatic pseudocyst has previously been reported from our institution.

Conclusions

This experience would indicate that endoscopic drainage of pancreatic pseudocyst is an effective and relatively safe option of managing this problem in children.     

Transpapillary stenting for pancreaticocutaneous fistulas

Because transpapillary stents have been successfully placed to treat the ductal disruptions associated with pseudocysts, pancreatic ascites and pleural effusions, and pancreaticoenteric fistulas, we reviewed our experience with endoscopically placed prostheses in patients who had persistent pancreaticocutaneous fistulas but an otherwise intact duct. Nine patients who underwent endoscopic transpapillary stent placement for ongoing pancreaticocutaneous fistulas at our institution were retrospectively reviewed. Fistulas were present for a mean (±SEM) of 35 ±11 days and averaged 225±55 ml of output daily. Etiology of the fistulas included percutaneous pseudocyst drainage in four patients, pancreatic necrosis in two, complications of pancreatic surgery in two, and perforation of the duct of Santorini at the time of minor aphincterotomy in one. All patients had an otherwise intact duct at the time of endoscopic retrograde cholangiopancreatography. Six patients had transpapillary stents placed that did not bridge the area of leakage and three had prostheses placed across the ductal disruption. Eight of nine fistulas were successfully closed by means of this technique including five within 48 hours. There was one instance of stent migration and one patient developed prosthesis occlusion and an infected pseudocyst, which was treated with stent exchange. Stents were retrieved 10 to 14 days after fistula closure and no patient has had a recurrence at a median follow-up of 3 years. Transpapillary stents appear to effect closure of pancreaticocutaneous fistulas that fail to respond to conventional therapy.     

Therapy of post-necrotic pancreatic pseudocysts: invasive treatments and their results

Pancreatic pseudocysts are the most common lesions of the pancreas. Endoscopic and US-endoscopic techniques are today the best minimally invasive diagnostic and therapeutic procedures available for this pathology. From January 1980 to December 2001 we observed a total of 74 patients with pancreatic pseudocysts secondary to acute pancreatitis. Twelve patients were treated by medical therapy, 37 with a surgical approach, 15 by endoscopic drainage and 10 by CT-guided drainage. The mean size of the pseudocysts was 12.9 cm (range: 3.4 to 24 cm) and 69.4% were larger than 10 cm. CT-guided drainage had a 50% complication rate (P = 0.00814), a 20% mortality rate (P = 0.00463) and a 10% relapse rate. The surgical approach was associated with a complication rate of 18.9% and a 5.4% relapse rate. The endoscopic approach presented a 13% morbidity rate and a 6.6% relapse rate. CT-guided drainage is the therapeutic approach we use in emergency cases, but endoscopic therapeutic technique is the best procedure and is a valid alternative to surgical and CT-guided drainage. The shortest mean hospital stay (4.8 days) was observed with the endoscopic approach.     

Conservative treatment as an option in the management of pancreatic pseudocyst

BACKGROUND: Management of pancreatic pseudocysts is associated with considerable morbidity (15-25%). Traditionally, pancreatic pseudocysts have been drained because of the perceived risks of complications including infection, rupture or haemorrhage. We have adopted a more conservative approach with drainage only for uncontrolled pain or gastric outlet obstruction. This study reports our experience. PATIENTS AND METHODS: A consecutive series of 36 patients with pancreatic pseudocysts were treated over an 11-year period in one district general hospital serving a population of 310,000. This study group comprised of 19 men and 17 women with a median age of 55 years (range, 10-88 years). Twenty-two patients had a preceding attack of acute pancreatitis whilst 12 patients had clinical and radiological evidence of chronic pancreatitis. The aetiology comprised of gallstones (16), alcohol (5), trauma (2), tumour (2), hyperlipidaemia (1) and idiopathic (10). RESULTS: All patients were initially managed conservatively and intervention, either by radiological-assisted external drainage or cyst-enteric drainage (by surgery or endoscopy), was only performed for persisting symptoms or complications. Patients treated conservatively had 6 monthly follow-up abdominal ultrasound scans (USS) for 1 year. Fourteen of the 36 patients (39%) were successfully managed conservatively, whilst 22 patients required intervention either by percutaneous radiological drainage (12), by endoscopic cystogastrostomy (1) or by open surgical cyst-enteric anastomosis (9). Median size of the pancreatic pseudocysts in the 14 patients managed conservatively (7 cm) was nearly similar to that of the 22 patients requiring intervention (8 cm). The most common indications for invasive intervention in the 22 patients were persistent pain (16), gastric outlet obstruction (4), jaundice (1) and dyspepsia with weight loss (1). Although one patient required surgery for persistent pain, no other patients required urgent or scheduled surgery for complications of untreated pancreatic pseudocysts. Two of the 12 patients treated by percutaneous radiological drainage had recurrence of pancreatic pseudocysts requiring surgery. Two patients developed an intra-abdominal abscess following cyst-enteric drainage of pancreatic pseudocysts and one patient had a pulmonary embolism. On the mean follow-up of 37.3 months, one patient with alcoholic pancreatitis died 5 months after surgical cyst-enteric bypass. CONCLUSIONS: These results suggest that many patients with pancreatic pseudocysts can be managed conservatively if presenting symptoms can be controlled.     

Endoscopic transgastric drainage of pancreatic pseudocyst with the use of Nd:YAG laser

Pancreatic pseudocysts have been successfully managed with endoscopic drainage recently. This report describes a case of endoscopic transgastric drainage using endoscopic ultrasonography (EUS) and an Nd:YAG laser. EUS was used to detect an optimal puncture site of the pseudocyst and to reduce the risk of bleeding and perforation. An Nd:YAG laser was used to minimize the risk of bleeding and to penetrate the thick wall of the pseudocyst. After transgastric cystgastrostomy was performed, an internal stent was placed between the pseudocyst and the stomach. There were no complications associated with endoscopic interventions. Complete resolution of the pseudocyst was observed. Endoscopic transgastric drainage of pancreatic pseudocysts is a recommended approach for selected patients with pancreatic pseudocysts that are uncomplicated and are located adjacent to the stomach. Safe and effective drainage can be achieved without hemorrhage and perforation with the use of EUS, an Nd:YAG laser, and a stent. Furthermore, the Nd:YAG laser facilitated passage through a markedly indurated pseudocyst wall and it seemed to be an effective instrument, especially for pseudocysts with a thick wall.     

Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts

Background

Transmural stents are placed at endoscopy to drain pancreatic fluid collections. This study evaluated the relationship between stent placement and treatment outcomes in patients undergoing endoscopic transmural drainage of uncomplicated pancreatic pseudocysts.

Methods

This is a retrospective study of all patients who underwent endoscopic drainage of uncomplicated pancreatic pseudocysts over a 10-year period. After dilating the transmural tracts in the range of 8–15 mm, single or multiple, 7 or 10Fr double-pigtail plastic stents were deployed. The main outcome measure was to evaluate the relationship between stent characteristics and the number of endoscopic interventions required to achieve resolution of the pancreatic pseudocyst (treatment success).

Results

Of 122 patients, 45 (36.9 %) had 10Fr stents of which 30 patients (66.7 %) had more than one stent; the remaining 77 (63.1 %) patients had 7Fr stents of which 56 (72.7 %) had more than one stent. The overall treatment success was 94.3 %. Treatment was successful in 102 patients (83.6 %) with one intervention; 13 patients (10.7 %) required re-intervention for successful drainage and 7 patients (5.7 %) failed endoscopic treatment. There was no significant difference in the number of interventions required for treatment success between patients with 7 or 10Fr stents (one intervention required in 87.7 vs. 90.5 %, respectively; p = 0.766) and between patients with 1 or >1 stent (one intervention required in 88.9 vs. 88.6 %, respectively; p = 0.999). On multiple logistic regression analysis, the stent size (OR 1.54; 95 % CI 0.23–10.4) and number (OR 1.15; 95 % CI 0.25–5.25) were not associated with the number of interventions required for treatment success when adjusted for pseudocyst size, location, drainage modality, the presence or absence of pancreatic duct stent and luminal compression.

Conclusions

There appears to be no relationship between the number of interventions required for treatment success and stent characteristics in patients undergoing endoscopic transmural drainage of uncomplicated pancreatic pseudocysts.     

Treatment of Acute Pancreatic Pseudocysts After Severe Acute Pancreatitis

Treatment of acute pancreatic pseudocysts (APP) after an episode of severe acute pancreatitis (SAP) remains controversial. Both population heterogeneity and limited numbers of patients in most series prevent a proper analysis of therapeutic results. The study design is a case series of a large, tertiary referral hospital in the surgical treatment of patients with APP after SAP. An institutional treatment algorithm was used to triage patients with complicated APP and organ failure based on Sequential Organ Failure Assessment scores to temporizing percutaneous or endoscopic drainage to control sepsis and improve their clinical condition before definitive surgical management. Over a 10-year period of study (December 1995 to 2005), 73 patients with APP after an episode of SAP were treated, 43 patients (59%) developed complications (infection 74.4%, perforation 21%, and bleeding 4.6%) and qualified for our treatment algorithm. Percutaneous/endoscopic drainage was successful in controlling sepsis in 11 of 13 patients (85%) with severe organ failure and allowed all patients to undergo definitive surgical management. The morbidity (7 vs 44.1%, P = 0.005) and mortality rates (0 vs 19%, P = 0.04) were significantly higher in complicated vs uncomplicated APP. Acute pancreatic pseudocysts after SAP are unpredictable and have a high incidence of complications. Once complications develop, there is a significantly higher morbidity and mortality rate. In complicated APP with severe organ failure, percutaneous/endoscopic drainage is useful in controlling sepsis and allowing definitive surgical management.     

ERCP in evaluating the mode of therapy in pancreatic pseudocyst

Twenty patients with ultrasonographic or computed tomographic diagnosis of pancreatic pseudocyst were referred for endoscopic retrograde cholangiopancreatography (ERCP). Two of these were found at laparotomy not to have pseudocysts and were excluded. Pancreatography was successful in 15 out of 18 cases (83%) and cholangiography in 12 out of 18 cases (67%). Three types of pseudocysts were noticed according to the communication of the pseudocyst to the main pancreatic duct and the presence of pancreatic duct stenosis. Successful treatment included two spontaneous resolutions, two internal drainages and three left pancreatic resections. In the eight percutaneous external drainages four recurrences (50%) occurred, one after closure of temporary pancreatocutaneous fistula. All the recurrences occurred in Type III pseudocysts with communication of the pseudocysts to stenotic main pancreatic duct. In these cases internal drainage would have been the preferable treatment method. We believe that by ERCP one can identify pseudocysts not suitable for external drainage.     

Pseudocyst treatment in chronic pancreatitis--surgical treatment of the underlying disease increases the long-term success

BACKGROUND: For reasons of persisting controversies concerning indications for surgery, we evaluated chronic pancreatitis patients following pancreatic head resection or drainage procedure for pseudocysts located in the pancreatic head. MATERIAL AND METHODS: 206 patients (166 male, 40 female) with chronic pancreatitis and pseudocysts in the pancreatic head were operated between April 1982 and July 2001. 169 patients (82%) were treated with the duodenum-preserving pancreatic head resection, a pseudocyst-jejunostomy was performed in 37 patients (18%). RESULTS: The hospital mortality was 0.4%. The late mortality was 19% in a median follow-up of 7.3 years. The rate of patients with complete relief of pain was significantly higher after resection compared to drainage procedure in the long-term follow-up (94 vs. 75%; p = 0.003). With regard to recurrence of pseudocysts, patients had an elevated rate of reoperations following drainage procedure (13 vs. 1%; p = 0.008). The endocrine function was significantly better preserved in patients of the drainage group compared to the resection group (no diabetes 67 vs. 35%, p < 0.01). CONCLUSION: The resection has, compared to drainage procedures alone, the advantage of low recurrence rate of pseudocysts and a high rate of pain-free patients in the long-term follow-up. However, the risk of diabetes is increased in the resection group.