Pancreatic pseudocyst should be treated by surgical drainage.

This debate reviews the arguments in favour of surgical or non-surgical techniques for the management of pancreatic pseudocysts. Surgery provides definitive management and has a low risk of recurrence; pancreatic resection may be required to achieve this. Surgical treatment of pancreatic pseudocyst is safe, with little morbidity and low mortality, and surgical drainage allows biopsy of the cyst wall to exclude a cystic neoplasm of the pancreas. Percutaneous techniques have the advantage of low morbidity and mortality, with less discomfort to the patient than a surgical incision. In selected patients, a good result can be anticipated. The balance of the evidence suggests that both approaches are useful in different patients. Pseudocyst management should be tailored to each individual case.