Surgical Endoscopy

, Volume 21, Issue 12, pp 2262–2267 | Cite as

Management of pancreatic pseudocyst in the era of laparoscopic surgery – Experience from a tertiary centre

  • Chinnusamy Palanivelu
  • Karuppuswamy Senthilkumar
  • Madathupalayam Velusamy Madhankumar
  • Pidigu Seshiyar Rajan
  • Alangar Roshan Shetty
  • Kalpesh Jani
  • Muthukumaran Rangarajan
  • Gobi Shanmugam Maheshkumaar



In the era of minimally invasive surgery, laparoscopy has a great role to play in the management of pseudocyst of pancreas. We present our surgical experience over the past 12 years (May 1994 to April 2006) in the management of pancreatic pseudocysts.

Materials and Methods

The total number of cases was 108, with 76 male and 32 female patients. Age ranged from 18 to 70 years. Duration of symptoms ranged from 45 days to 7 months. Fifty-nine patients presented with pain abdomen. Sixty-one patients had co-morbid illness. Ten patients had abdominal mass on clinical examination. Predisposing factors were gallstones in 58 cases, alcohol in 20 cases, trauma in eight cases and post-pancreatectomy in one case. In 21 cases there are no predisposing factors.


All the cases were successfully operated without any significant intraoperative complication. Laparoscopic cystogastrostomy was done in 90 cases (83.4%), laparoscopic cystojejunostomy in eight cases (7.4%), open cystogastrostomy in two cases (1.8%), and laparoscopic external drainage in eight cases (7.4%). Laparoscopic cholecystectomy was done in 47 cases along with the drainage procedure. The mean operating time was 95 minutes. Mean blood loss was 69 ml. Mean hospital stay was 5.6 days. Percutaneous tube drain to assist decompression of the cyst was kept in all the laparoscopic cystojejunostomy (LCJ) group. Two patients were re-operated for bleeding and gastric outlet obstruction. We had no mortality in the postoperative period. With mean follow up of 54 months (range 3–145 months); only one patient who underwent laparoscopic cystogastrostomy (LCG) earlier in this series had recurrence due to inadequate stoma size. This patient later underwent OCG


Laparoscopy has a significant role to play in the surgical management of pseudocysts with excellent outcome. It offers all the benefits of minimally invasive surgery to the patients.


Pancreatic pseudocyst Laparoscopy Cystogastrostomy Cystojejunostomy External drainage Pancreatitis 


  1. 1.
    Ammori BJ (2003) Pancreatic surgery in the laparoscopic era. J Pancreas 4: 187–192Google Scholar
  2. 2.
    Baron TH, Harewood GC, Morgan DE, Yates MR (2002) Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 56: 7–17CrossRefPubMedGoogle Scholar
  3. 3.
    Beckingham IJ, Krige JE, Bornman PC, Terblanche J (1997) Endoscopic management of pancreatic pseudocysts. Br J Surg 84: 1638–1645CrossRefPubMedGoogle Scholar
  4. 4.
    Beckingham IJ, Krige JE, Bornman PC, Terblanche J (1999) Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 94: 71–74CrossRefPubMedGoogle Scholar
  5. 5.
    Bhattacharya D, Ammori BJ (2003) Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature. Surg Laparosc Endosc Percutan Tech 13: 141–148CrossRefPubMedGoogle Scholar
  6. 6.
    Binmoeller KF, Seifert H, Walter A, Soehendra N (1995) Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 42: 219–224CrossRefPubMedGoogle Scholar
  7. 7.
    Bodker A, Kjaergaard J, Schmidt A, Tilma A (1981) Pancreatic pseudocysts. A follow-up study. Ann Surg 194: 80–84Google Scholar
  8. 8.
    Bradley EL, 3rd (1993) A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 128: 586–590PubMedGoogle Scholar
  9. 9.
    Bumpers HL EL B (1998) Treatment of pancreatic pseudocysts. In Howard J, Idezuki Y, Ihse IPrinz R (eds) Surgical Disease of the Pancreas. Williams & Wilkins Baltimore 423–432Google Scholar
  10. 10.
    Cooperman AM (2001) An overview of pancreatic pseudocysts: the emperor’s new clothes revisited. Surg Clin N Am 81: 391–397; xiiCrossRefPubMedGoogle Scholar
  11. 11.
    Cooperman AM (2001) Surgical treatment of pancreatic pseudocysts. Surg Clin N Am 81: 411–419; xiiCrossRefPubMedGoogle Scholar
  12. 12.
    Cremer M, Deviere J, Baize M, Matos C (1990) New device for endoscopic cystoenterostomy. Endoscopy 22: 76–77CrossRefPubMedGoogle Scholar
  13. 13.
    Gerolami R, Giovannini M, Laugier R (1997) Endoscopic drainage of pancreatic pseudocysts guided by endosonography. Endoscopy 29: 106–8CrossRefPubMedGoogle Scholar
  14. 14.
    Grace PA, Williamson RC (1993) Modern management of pancreatic pseudocysts. Br J Surg 80: 573–581CrossRefPubMedGoogle Scholar
  15. 15.
    Gumaste VV, Pitchumoni CS (1996) Pancreatic pseudocyst. Gastroenterologist 4: 33–43PubMedGoogle Scholar
  16. 16.
    Hariri M, Slivka A, Carr-Locke DL, et al. (1994) Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized. Am J Gastroenterol 89:1781–1784PubMedGoogle Scholar
  17. 17.
    Heider R, Meyer AA, Galanko JA, Behrns KE (1999) Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients. Ann Surg 229: 781–787; discussion 787–9CrossRefPubMedGoogle Scholar
  18. 18.
    Kiviluoto T, Kivisaari L, Kivilaakso E, Lempinen M (1989) Pseudocysts in chronic pancreatitis. Surgical results in 102 consecutive patients. Arch Surg 124: 240–243PubMedGoogle Scholar
  19. 19.
    Lawson JM, Biallie J, (1995) Endoscopic therapy for pancreatic pseudocysts. Gastrointest Clin N Am 5: 181–193Google Scholar
  20. 20.
    Moran B, Rew DA, Johnson CD (1994) Pancreatic pseudocyst should be treated by surgical drainage. Ann R Coll Surg Engl 76: 54–58PubMedGoogle Scholar
  21. 21.
    Mori T, Abe N, Sugiyama M, Atomi Y, Way LW (2000) Laparoscopic pancreatic cystgastrostomy. J Hepatobiliary Pancreat Surg 7: 28–34CrossRefPubMedGoogle Scholar
  22. 22.
    Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236: 149–158CrossRefPubMedGoogle Scholar
  23. 23.
    Pedrazzoli S, Sperti C, Pasquali C (2001) Pancreatic head resection for noninflammatory benign lesions of the head of the pancreas. Pancreas 23: 309–315CrossRefPubMedGoogle Scholar
  24. 24.
    Rosso E, Alexakis N, Ghaneh P, Lombard M, Smart HL, Evans J, Neoptolemos JP (2003) Pancreatic pseudocyst in chronic pancreatitis: endoscopic and surgical treatment. Dig Surg 20: 397–406CrossRefPubMedGoogle Scholar
  25. 25.
    Sahel J, Bastid C, Pellat B, Schurgers P, Sarles H (1987) Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 2: 447–453CrossRefPubMedGoogle Scholar
  26. 26.
    Smits ME, Rauws EA, Tytgat GN, Huibregtse K (1995) The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastsrointest Endosc 42: 202–207CrossRefGoogle Scholar
  27. 27.
    Usatoff V, Brancatisano R, Williamson RC (2000) Operative treatment of pseudocysts in patients with chronic pancreatitis. Br J Surg 87: 1494–1499CrossRefPubMedGoogle Scholar
  28. 28.
    Vidyarthi G, Steinberg SE (2001) Endoscopic management of pancreatic pseudocysts. Surg Clin N Am 81: 405–410, xiiCrossRefPubMedGoogle Scholar
  29. 29.
    Vitas GJ, Sarr MG (1992) Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery 111: 123–130PubMedGoogle Scholar
  30. 30.
    Warshaw AL, Rattner DW (1985) Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria. Ann Surg 202: 720–724PubMedCrossRefGoogle Scholar
  31. 31.
    Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL (1990) The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 170: 411–417PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Chinnusamy Palanivelu
    • 1
  • Karuppuswamy Senthilkumar
    • 1
  • Madathupalayam Velusamy Madhankumar
    • 1
  • Pidigu Seshiyar Rajan
    • 1
  • Alangar Roshan Shetty
    • 1
  • Kalpesh Jani
    • 1
  • Muthukumaran Rangarajan
    • 1
  • Gobi Shanmugam Maheshkumaar
    • 1
  1. 1.GEM HospitalCoimbatoreIndia

Personalised recommendations