Management of Symptomatic Pancreatic Pseudocyst

  • Benjamin D. Ferguson
  • Vivek N. PrachandEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Management options for pancreatic pseudocyst are numerous and include endoscopic and surgical approaches. Much debate exists regarding which of these approaches is superior and when each is most appropriate. While endoscopy offers less post-procedural pain, shorter length of stay, and fewer complications, laparoscopic surgical approaches are more suitable for pseudocysts whose locations or other characteristics present significant technical challenge or are otherwise unamenable to endoscopic drainage. Endoscopic management should be attempted when technically feasible, and a laparoscopic approach should be employed when endoscopic drainage would be technically difficult or in symptom recurrence following initial endoscopic management.


Pancreatic pseudocyst Laparoscopy Endoscopy Cystgastrostomy 


  1. 1.
    Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145(3):583–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Melman L, Azar R, Beddow K, Brunt LM, Halpin VJ, Eagon JC, Frisella MM, Edmundowicz S, Jonnalagadda S, Matthews BD. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Surg Endosc. 2009;23(2):267–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Nealon WH, Walser E. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg. 2005;241(6):948–57.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Palanivelu C, Senthilkumar K, Madhankumar MV, Rajan PS, Shetty AR, Jani K, Rangarajan M, Maheshkumaar GS. Management of pancreatic pseudocyst in the era of laparoscopic surgery – experience from a tertiary centre. Surg Endosc. 2007;21(12):2262–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Dávila-Cervantes A, Gómez F, Chan C, Bezaury P, Robles-Díaz G, Uscanga LF, Herrera MF. Laparoscopic drainage of pancreatic pseudocysts. Surg Endosc. 2004;18(10):1420–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Hauters P, Weerts J, Navez B, Champault G, Peillon C, Totte E, Barthelemy R, Siriser F. Laparoscopic treatment of pancreatic pseudocysts. Surg Endosc. 2004;18(11):1645–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Hindmarsh A, Lewis MPN, Rhodes M. Stapled laparoscopic cystgastrostomy: a series with 15 cases. Surg Endosc. 2005;19(1):143–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Barragan B, Love L, Wachtel M, Griswold JA, Frezza EE. A comparison of anterior and posterior approaches for the surgical treatment of pancreatic pseudocyst using laparoscopic cystogastrostomy. J Laparoendosc Adv Surg Tech A. 2005;15(6):596–600.CrossRefPubMedGoogle Scholar
  9. 9.
    Oida T, Mimatsu K, Kawasaki A, Kano H, Kuboi Y, Aramaki O, Amano S. Long-term outcome of laparoscopic cystogastrostomy performed using a posterior approach with a stapling device. Dig Surg. 2009;26(2):110–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Weckman L, Kylänpää M-L, Puolakkainen P, Halttunen J. Endoscopic treatment of pancreatic pseudocysts. Surg Endosc. 2006;20(4):603–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Varadarajulu S, Bang JY, Phadnis MA, Christein JD, Wilcox CM. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg. 2011;15(11):2080–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Sharma SS, Bhargawa N, Govil A. Endoscopic management of pancreatic pseudocyst: a long-term follow-up. Endoscopy. 2002;34(3):203–7.PubMedGoogle Scholar
  13. 13.
    Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc. 2002;56(1):7–17.CrossRefPubMedGoogle Scholar
  14. 14.
    Will U, Wegener C, Graf K-I, Wanzar I, Manger T, Meyer F. Differential treatment and early outcome in the interventional endoscopic management of pancreatic pseudocysts in 27 patients. World J Gastroenterol. 2006;12(26):4175–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kahaleh M, Shami VM, Conaway MR, Tokar J, Rockoff T, La Rue De SA, de Lange E, Bassignani M, Gay S, Adams RB, Yeaton P. Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy. 2006;38(4):355–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68(6):1102–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Sharma SS, Maharshi S. Endoscopic management of pancreatic pseudocyst in children-a long-term follow-up. J Pediatr Surg. 2008;43(9):1636–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Park DH, Lee SS, Moon S-H, Choi SY, Jung SW, Seo DW, Lee SK, Kim M-H. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41(10):842–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Will U, Wanzar C, Gerlach R, Meyer F. Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necroses – treatment algorithm in a large single-center study. Ultraschall Med. 2011;32(2):176–83.CrossRefPubMedGoogle Scholar
  20. 20.
    Seewald S, Ang TL, Richter H, Teng KYK, Zhong Y, Groth S, Omar S, Soehendra N. Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections. Dig Endosc. 2012;24(1):36–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Chicago Medical CenterChicagoUSA

Personalised recommendations