Twenty-five year experience with pancreatic pseudocysts. Are we making progress?

Pseudocysts of the pancreas continue to pose a dilemma to both the internist and the surgeon alike when attempting to establish a rational means of management. Although ardent strides have been made in the realm of diagnosis and follow-up with the advent of ultrasonography, mortality and morbidity have not changed appreciably over the past 20 years. Although internal drainage is the desired method of surgical management, not all pseudocysts are amenable to this approach. Thus, the operative procedure should be strictly tailored to the patient's particular clinical situation so that acceptable long-term results can usually be obtained. By incorporating parenteral hyperalimentation into the immediate postoperative treatment period, it is postulated that surgical morbidity can be decreased. It has been unequivocally demonstrated that spontaneous resolution does occur in a significant number of patients, but until a reliable means of assessing the natural history of a particular pseudocyst is established, these lesions of the pancreas remain a surgical problem.