• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / A Hybrid Laparoscopic-Endoscopic Cystogastrostomy for Pancreatic Pseudocysts

A Hybrid Laparoscopic-Endoscopic Cystogastrostomy for Pancreatic Pseudocysts

Michael P Meara, MD, MBA1, Edward L Jones, MD2, David R Renton, MD1. 1The Ohio State University Wexner Medical Center, 2Univ. of Colorado and The Denver VA Medical Center

Background:  Cystogastrostomy has been the procedure of choice for large, symptomatic pancreatic pseudocysts.   Multiple methods have been developed for creating cystogastrostomies.  These include traditional open techniques, laparoscopic approaches, and endoscopic drainage procedures.  This video presents a novel method for a combined laparoscopic and endoscopic approach to pancreatic pseudocyst drainage.

The patient is a 48 year-old Caucasian female.  She has a past surgical history significant for 14 previous abdominal operations including cholecystectomy and a combination of 11 previous hernia repairs.  The patient’s repairs have been complicated by dehiscence and multiple fistulas.  She presented to the hospital for admission with medication-induced pancreatitis and a large, well formed pancreatic pseudocyst  

Methods:  In light of the patients previous operations, the decision was made to attempt a combined laparoscopic and endoscopic cystogastrostomy to avoid formal laparotomy.  Standard upper endoscopy was performed and the cyst was immediately encountered upon entering the stomach.  The scope was advanced distally and placed within the retroflexion view for the best visual approach to the superior cyst.  A site on the anterior abdominal wall was selected and a 12 mm trocar was placed under direct visualization.

Next, a laparoscopic aspiration needle was introduced into the stomach and the cyst was accessed.  Old blood and liquefactive pancreas was freely aspirated from the cyst.  A wire was left in the cyst to maintain the tract within the cyst.  An injection catheter was then advanced into the cyst cavity.  The cyst was distended with radiopaque dye to confirm adequate positioning prior to the creation of the cyst gastrostomy. 

The catheter was removed and an ultrasonic dissection device was introduced into the common channel between the gastric and cyst wall.  The channel was widened to facilitate introduction of a laparoscopic stapler.  A laparoscopic staple load was introduced into the cyst and fired.  The endoscope was then advanced into the cyst cavity under direct vision confirming that all collections within the cyst were adequately drained.  A second firing of the stapler was performed to complete our cystogastrostomy.  Finally, in light of the patient’s additional issues, a feeding tube was placed via the trocar site to allow for healing of the tract and reliable enteric access.

Conclusions: This maneuver can be completed safely and effectively.  This hybrid approach represents a novel method for drainage of pancreatic pseudocysts in this complex patient.

Key Words: Endoscopic Cystogastrostomy – Laparoscopic Cystogastrostomy – Pancreatic Pseudocyst – Walled-Off Pancreatic Necrosis  

395

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals