Is there a place and indication for external drainage procedures in the surgery of pancreatic pseudocysts?

Introduction: Authors earlier reported results of the surgery of pancreatic pseudocysts. They concluded that internal drainage into the gastrointestinal tract has low morbidity and mortality rates in cases of chronic pancreatitis complicated with pancreatic pseudocysts.

Aim: Although higher morbidity, reoperation's rate and mortality external drainage procedures are common in pancreatic surgery (30%). Therefore the authors search the circumstances which indicate external drainage procedure in the surgery of pancreatic pseudocysts.

Discussion: The two main reasons of external drainage procedures in the surgery of pancreatic pseudocysts are:

• The content of pancreatic pseudocyst is not always clear, but inhomogenous, purulent, filled with detritus or necrotised pancreatic tissue.

• The wall of pancreatic pseudocyst in some cases is very thin, vulnerable, “immaturate” inflammed tissue, which is not appropriate for a safe anastomosis.

We can see such morphology in patients after conservative treatment of acute pancreatitis, in cases of the so called “postacute pancreatic pseudocysts”. On the other hand chronic pancreatitis patients after acute inflammatory exacerbation can produce the same morphology.

Conclusions: The appearence of pancreatic pseudocysts in the inflammatory diseases of pancreas can be very different, according to the grades of disease. The content of intra- or extrapancreatic fluid collections, the quality of the pseudocyst's wall indicate the decision of the surgeon, whether he can perform a safe anastomosis into the gastrointestinal tract or not.