Our Method of Internal Drainage of Pancreatic Pseudocysts Accomplished By Minimally Invasive Laparoscopic Approaches

SHOJI FUKUYAMA, MD PhD, YOSHINAO KIMURA, MD PhD, YASUYUKI NAKAJIMA, MD PhD. NAKAJIMA HOSPITAL

INTRODUCTION: In spite that indications of laparoscopic surgery have been spreading for various kinds of diseases, the number of laparoscopic surgery for pancreatic disease is still low compared to other abdominal diseases.
Pseudocyst is one of the late complications after acute pancreatitis.
Drainage often needs to be considered if the pseudocyst is not disappeared spontaneously in clinical course.
Since we developed a laparoscopic method of the internal drainage for the pancreatic pseudocyst, we introduce the methods and procedures by reporting a clinical case.
METHODS AND PROCEDURES: Clinical case is a 62 years old male. He felt abdominal pain after lunch. After examination, he was diagnosed as acute pancreatitis, and transferred to the hospital with severity score 5. Arterial infusion therapy was commenced immediately. Symptoms were ameliorated but pesudocyst formed. There was no sign of decreasing. We decided cystojejunostomy as the internal drainage for the pancreatic pseudocyst. We started the operation with spine position and identified a pseudocyst under the greater omentum by the scope. Then we punctured the pseudocyst by the Balloon Catheter, and inflated the Balloon and sucked the content inside. We confirmed the inside of the pseudocyst after deflating the Balloon, and made a small incision on the surface of the jejunum. Next we applied the EndoGIA™ to the incision, and closed the hole manually. After completing the anastomosis, a drain was introduced near the anastomosis. The operation time was 242 minutes and the hospital stay was 12 days. After operation, medium grade fever continued for 3 days. However, the fever spontaneously ameliorated. After diet commenced at the fifth postoperative day, diarrhea was recognized and treated conservatively.
RESULTS: We completed 4 cystojejunostomies (CJ) and 2 cystogastrostomies (CG) as the internal drainage for the pancreatic pseudocyst. The operation time of CJ tends to be shorter, but regarding hospital stay, there is no difference among CJ, CG and open procedure.
CONCLUSION: The procedure is safe and feasible. We will continue to perform laparoscopic surgery not only for the pseudocyst but also for other pancreatic disease in order to collect the data and to confirm the safety and validity of these operations.