New techniques in the management of pancreatic pseudocysts.

The results of an analysis on the mortality-morbidity data of 1698 operations performed for the treatment of chronic pancreatitis and/or its complications at the First Department of Surgery of Semmelweis University Medical School between 1975 and 1995 are presented herein. Special attention was focused on the effectiveness of such recently introduced techniques as posterior cystogastrostomy, cysto-Wirsungo gastrostomy, modified pylorus-preserving pancreatoduodenectomy, and blunt transparenchymal cystoduodenostomy. The posterior cystogastrostomy is technically easier to perform that the traditional Juras operation, as only the posterior ventricular wall needs to be cut open, and it can be combined with decompression-type operations. On the other hand, the cysto-Wirsungo gastrostomy achieves a long-lasting effect, and the cyst drainage in this operation ensures decompression. Moreover, if this operation is performed at an early stage, the progression of chronic pancreatitis is slowed down. The modified pylorus-preserving pancreatoduodenectomy eliminates the disadvantages of the Whipple operation and is a commonly performed operation for chronic pancreatitis localized within the head of the pancreas. However, since the introduction of the blunt transparenchymal cystoduodenostomy, the number of pancreatoduodenectomies has been reduced by 60%. This is an effective method with long-lasting results for the treatment of smaller cysts localized deeply in the head of the pancreas. The findings of this study strongly suggest that that these procedures give significantly better results for certain pathological conditions such as pancreatic pesudocysts than traditional methods.