Cystoduodenostomy. New perspectives.

Cystoduodenostomy for internal drainage of pancreatic pseudocysts has been both condemned and condoned. The current study reports the largest personal experience with a single method of cystoduodenostomy. Transduodenal cystoduodenostomy was performed in 14 cases followed an average of 39 months without mortality, fistula formation, abscess, or hemorrhage. Recurrent pseudocysts developed in two patients, neither in the pancreatic head. In a 15-year combined review of surgical procedures for pancreatic pseudocyst, transduodenal cystoduodenostomy evidenced mortality rates similar to other forms of internal drainage. In direct contrast, laterolateral cystoduodenostomy by suture anastomosis resulted in a 70% mortality rate and should rarely, if ever, be performed.