Pancreatic Cysts Treatment

Treatment Approach

Our approach to pancreatic cyst treatment combines precision with personalized care. The process begins with a comprehensive evaluation including specialized pancreatic protocol imaging (MRI/MRCP), endoscopic ultrasound with possible fluid sampling, and detailed analysis of cyst characteristics to determine its exact nature. Notably, our expertise in selecting the most appropriate intervention based on cyst type, location, and your individual circumstances. 
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For inflammatory pseudocysts requiring drainage, we offer four specialized approaches:

Cystogastrostomy: This procedure creates a permanent connection between the pseudocyst and the stomach, allowing continuous internal drainage. Our approach utilizes either endoscopic techniques—creating the connection through the stomach wall using specialized endoscopes—or surgical methods (laparoscopic or open) that suture or staple the cyst wall directly to the posterior stomach wall. We prefer this approach when the pseudocyst is firmly adherent to the posterior stomach, allowing gravity to naturally assist drainage and providing excellent long-term results for appropriately selected patients.
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Cystoduodenostomy: Similar to cystogastrostomy, this technique creates a permanent connection between the pseudocyst and the duodenum (first portion of small intestine). We select this approach when the pseudocyst is anatomically positioned adjacent to the duodenum, particularly for cysts in the pancreatic head region. Using either endoscopic or surgical techniques, we create a precise anastomosis that provides dependable drainage while preserving surrounding structures and natural digestive pathways.

Cystojejunostomy: This more complex drainage approach connects the pseudocyst to a loop of the jejunum (middle portion of the small intestine) using a Roux-en-Y configuration. We employ this technique for pseudocysts not immediately adjacent to the stomach or duodenum, or when previous surgeries have altered upper abdominal anatomy. Through either laparoscopic or open techniques, we mobilize a section of the small intestine to create a dedicated drainage pathway, ensuring effective decompression even for challenging cyst locations.

Cystectomy (Complete Excision): For certain cyst types—particularly mucinous cystic neoplasms, some IPMNs, and other concerning lesions—we perform complete surgical removal rather than drainage. This approach may range from simple excision of the cyst alone to distal pancreatectomy (removal of the pancreatic tail) or even pancreaticoduodenectomy (Whipple procedure) depending on the cyst location and characteristics. We prioritize minimally invasive techniques when oncologically appropriate while ensuring complete removal of potentially precancerous or malignant lesions.

Throughout your care journey, our multidisciplinary team includes dedicated gastroenterologists, interventional radiologists, pancreatic surgeons, and pancreatic specialists who collaborate to provide comprehensive care before, during, and after your procedure. This team approach ensures both technical excellence in your procedure and ongoing monitoring of pancreatic function, optimizing both immediate results and long-term outcomes.

Potential Risks

Common Side Effects

• For Endoscopic Approaches:
  

  • Mild throat discomfort from the endoscope

  • Temporary bloating or gas pain

  • Minor bleeding at the drainage site that resolves quickly

  • Brief episodes of nausea following the procedure

• For Laparoscopic Approaches:
  

  • Temporary pain at incision sites

  • Shoulder pain from residual CO2 gas

  • Minor bruising around port sites

  • Short-term digestive adjustment

• For Open Surgery or Cystectomy:
  

  • Incisional discomfort during the healing phase

  • Temporary changes in bowel habits

  • Fatigue during the recovery period

  • Need for temporary dietary modifications

• For All Approaches:
  

  • Transient elevation in pancreatic enzyme levels

  • Short-term changes in digestive comfort

  • Some patients experience temporary food intolerances

Less Common Complications

• For Drainage Procedures:
  

  • Infection of the cyst cavity

  • Bleeding at the anastomosis site

  • Premature closure of the drainage pathway

  • Incomplete drainage requiring additional intervention

  • Damage to surrounding structures during access

• For Cystectomy:
  

  • Pancreatic fistula formation

  • Post-operative pancreatitis

  • Infection requiring antibiotics or drainage

  • Bleeding requiring transfusion or reoperation

  • Injury to surrounding structures (spleen, blood vessels)

• For All Approaches:
  

  • Surgical site infection

  • Development of diabetes after significant pancreatic resection

  • Recurrent cyst formation

  • Exocrine pancreatic insufficiency requiring enzyme supplementation

  • Missed diagnosis of malignancy (if cyst contained cancer cells)

  • Need for additional or more extensive procedures

When to Seek Immediate Medical Attention

• Fever over 101°F (38.3°C)

• Severe, worsening abdominal pain

• Persistent nausea or vomiting

• Inability to tolerate liquids for 24 hours

• Significant bleeding (vomiting blood or passing black stools)

• Increasing abdominal distension or bloating

• Signs of infection around incisions

• Jaundice (yellowing of skin or eyes)

• Severe weakness, lightheadedness, or confusion

• Chest pain or difficulty breathing

• Severe diarrhea or signs of dehydration

• Return of original symptoms after initial improvement

• New or different abdominal pain pattern