An Overview of Pancreatic Pseudocysts

In the past, the indications, timing, and methods to treat pancreatic pseudocysts have created confusion, misunderstanding, and disagreement among surgeons and gastroenterologists. The confusion is perpetuated partly by long-held beliefs based on individual or anecdotal experiences with pseudocysts in dissimilar groups of patients. Before axial body imaging, it was not possible to follow up on pancreatic pseudocysts, and it was difficult to refute these beliefs because surgery was the only available method to treat pancreatic pseudocysts and confirm the diagnosis. The only questions concerning pancreatic pseudocysts were when to perform surgery and which surgical procedure to perform, not whether surgery was indicated. In large part, this was because only large, symptomatic pancreatic pseudocysts were detectable. To this author, perpetuation of this management tradition is analogous to admiring “the emperor's new clothes”: It ignores data accumulated over the past 70 years. Revisiting the subject of pancreatic pseudocysts with open eyes will shed new light on old surgical traditions.