"Duct Drainage Alone is Sufficient in the Operative
Management of Pancreatic Pseudocyst in
Patients With Chronic Pancreatitis"
William H. Nealon, MD, and Eric Walser, MD
From the Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
Objective
To test a hypothesis that definitive management of pseudocyst
associated with chronic pancreatitis is predicated on addressing
pancreatic ductal anatomy.
Summary Background Data
The authors have previously confirmed the impact of pancreatic
ductal anatomic abnormalities on the success of percutaneous
drainage of pancreatic pseudocyst. The authors have
further defined a system to categorize the pancreatic ductal
abnormalities that can be seen with pancreatic pseudocyst.
The authors have published, as have others, the usefulness of
defining ductal anatomy when managing pancreatic pseudocysts
associated with chronic pancreatitis.
Methods
Beginning in 1985, all patients with pseudocyst who were
candidates for intervention (operative, percutaneous, or endoscopic)
have undergone endoscopic retrograde cholangiopancreatography
(ERCP). An associated diagnosis of chronic
pancreatitis was established by means of ERCP findings. Patients
were candidates for longitudinal pancreaticojejunostomy
(LPJ) if they had a pancreatic ductal diameter greater
than 7 mm. In a nonrandomized fashion, patients were managed
with either combined simultaneous LPJ and pseudocyst
drainage or with LPJ alone.
Results
Two hundred fifty-three patients with pseudocyst have been
evaluated. Among these there have been 103 patients with
chronic pancreatitis and main pancreatic duct (MPD) dilatation
( 7 mm). Among these 103 patients, 56 underwent combined
LPJ/pseudocyst drainage and 47 had LPJ alone. Compared
to combined LPJ/pseudocyst drainage, the patients
undergoing LPJ alone had a shorter operative time, slightly
less transfusion requirement, slightly reduced length of hospital
stay, and slightly reduced complication rate. Long-term pain relief was achieved in 90%, and pseudocyst recurrence was less than 1%. Rates of each of these long-term outcomes
were nearly incidental among the two groups.
Conclusions
Ductal drainage alone (LPJ) is sufficient in patients with
chronic pancreatitis (MPD 7 mm) and an associated
pseudocyst. Simultaneous drainage of pseudocyst is not
necessary.
ANNALS OF SURGERY
Vol. 237, No. 5, 614–622
© 2003 Lippincott Williams & Wilkins, Inc.
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