Drainage of pancreatic pseudocysts can be performed either percutaneously, endoscopically or surgically. 

Percutaneous drainage of pseudocyst is the least employed technique. Endoscopic drainage is the treatment of choice if there is abutment of the pseudocyst against the stomach or duodenal wall. The procedure involves endoluminal ultrasonographically guided transgastric puncture of the pseudocyst, insertion of single or multiple stents, and – if necessary – transpapillary stenting of the pancreatic duct. 

Surgical drainage is indicated when endoscopic drainage is not feasible (there is no abutment of the pseudocyst against the stomach or duodenum, there is extensive collateral circle) or after multiple endoscopic drainage failure. 

The surgical approach involves a pseudocystogastrostomy on the posterior stomach wall (that can be fashioned via an anterior gastrotomy), or a pseudocystojejunostomy on a Roux-en-Y loop. The pseudocyst wall should be thick and solid enough to allow the fashioning of the anastomosis.