Changing patterns in the management of pancreatic pseudocysts.

The records of patients treated from 1938 through June, 1974, for pancreatic cysts have been reviewed. There was 205 cysts including 168 pseudocysts, 21 neoplastic, 13 retention, and 3 congenital pseudocysts. An analysis of two eras has been made: cysts treated prior to 1962 (56 patients) and cysts treated after 1962 (98 patients). In the earlier era 66.4% of patients were treated by external drainage and 34% by excision or internal drainage. By marked contrast in the more recent era only 27% were treated by external drainage and 73% by excision or internal drainage. The recurrence rate fell from 27% in the earlier era to 6% in the modern era. Improved morbidity was evidenced by a reduction from 32.2% to 15.3% in additional procedures required. Individualization in the treatment of pseudocyts with adherence to establish criteria for procedure selection with increased reliance on excision or internal drainage, as well as early diagnosis and timely intervention have improved the results of surgical therapy in this disease.