The timing of surgical treatment of pancreatic pseudocysts.

In an attempt to provide practical guidelines for the management of pancreatic pseudocysts, the results in 114 patients were analyzed from the perspective of the timing of operative intervention. Over-all, the patients undergoing surgical therapy during the first six weeks after pseudocyst formation had higher rates postoperatively of morbidity, mortality and recurrence than did those treated later in the course of the disease. However, further subdivision of the data revealed that the results in patients with uncomplicated pseudocysts were similar, irrespective of the timing of operative treatment. Operative intervention in patients with a pseudocyst who were acutely ill was risky at any time in the course of the disease. Based upon our results and upon information available in the literature, the optimal timing of the operation in patients with uncomplicated pseudocysts appears to be about four weeks after formation of the mass. The utility of ultrasound evaluation in making a surgical decision is also discussed.