Laparoscopic Cystgastrostomy

Laparoscopic drainage is a definitive and effective treatment for symptomatic pancreatic pseudocysts. Pancreatic pseudocysts are pancreatic fluid collections that develop a defined fibrous wall without a true epithelial lining. These are usually caused by acute or chronic pancreatitis or trauma with disruption of the pancreatic duct. 85% resolve spontaneously in six weeks. Large pseudocysts can cause a variety of symptoms including abdominal pain, gastrointestinal obstruction with nausea and vomiting, biliary obstruction, thrombosis of surrounding veins, hemorrhage, infection, and fistula.

This video is a case review of a 40 year old male with a history of gallstone pancreatitis with a resulting symptomatic pancreatic pseudocyst. The history and imaging studies are presented and the surgical technique of laparoscopic management via cystgastrostomy is detailed in video format.

The patient survived severe, necrotizing, gallstone pancreatitis but subsequently developed a large pancreatic pseudocyst. He suffered from chronic pain requiring high dose narcotics and obstructive symptoms of nausea and vomiting requiring nasojejunal enteral nutrition. The pseudocyst failed to resolve after six weeks and endoscopic transpapillary stenting. Once a mature pseudocyst wall was demonstrated on CT scan with fusion to the posterior gastric wall, a laparoscopic cystgastrostomy was performed. In particular, the gastrostomy was created in a diamond shape with four stapler firings. This technique created a generous opening with a low probability of premature closing and created a cyst wall specimen that could be sent to pathology to rule out malignancy. The patient did extremely well with resolution of symptoms, weight regain, elimination of narcotics, and a return to work as a pilot.

Laparoscopic transgastric drainage is a preferred and effective approach to the management of symptomatic pancreatic pseudocysts located posterior to the stomach.

Session: Video Channel

Program Number: V063

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