Surgical Management of Pediatric Pancreatic Pseudocysts When Endoscopic Drainage is Not Feasible: Illustrative Case and Review of Approaches.

Pancreatic pseudocysts in children are uncommon, and while most resolve spontaneously, a subset requires intervention. Endoscopic ultrasound-guided drainage has become the preferred modality in adults; however, its use in pediatrics is limited by patient size, anatomy, and availability of appropriately sized equipment. This manuscript reviews operative management strategies for pediatric pancreatic pseudocysts when endoscopic drainage is not feasible. Surgical alternatives include laparoscopic cystogastrostomy, which offers minimally invasive access for cyst drainage; open cystogastrostomy, which remains a reliable option when exposure, anatomy, or safety concerns preclude laparoscopy; and stapler-assisted techniques that facilitate creation of a wide, secure cystogastrostomy to reduce recurrence. Within this framework, we present an illustrative case of an eight-year-old patient with a large retrogastric pseudocyst who was not a candidate for endoscopic drainage and underwent successful open, stapler-assisted transgastric cystogastrostomy. The outcome highlights the continued relevance of surgical drainage as a safe and effective treatment pathway when endoscopic intervention cannot be performed.