Laparoscopic Transgastric Drainage of Complex Peripancreatic Fluid Collections
presented by W. Cory Johnston, MD, at the Sages 2014 Meeting; Panel – Concurrent Session SS13 V030
W. Cory Johnston, MD, Pippa Newell, MD, Paul Hansen, MD, Chet Hammill, MD, Ronald Wolf, MD; Providence Cancer Center, The Oregon Clinic, Foundation for Surgical Innovation and Education
Points of interest:
candidates for the surgery described–17 sec
gastric access and diagnostic endoscopy & placement of transgastric ports–28 sec
laparoscopic transgastric ultrasound –1:38
Keyword(s): 12 mm trocar, 3.4-4.5mm staples, 5 mm trocar, 6 cm cyst gastrostomy, 60 mm endostapling device, abscess cavity, adequate drainage, adjunct to nonsurgical treatment, air leaks, alternative to transperitoneal surgical techniques, anorexia, antrum, body of the stomach, candidate for surgery, chest CT, CHF exacerbation, clear fluid expressed, complete resolution, complex retrogastric parapancreatic fluid collections, cyst resolution, debridement of abscess cavity, definitive drainage, definitive management of pancreatic pseduocysts, definitive treatment, deposited necrotic debris, diagnostic endoscopy, diet was resumed, dilating trocar system, discharged on POD 1, disruption of lifestyle, distal pancreatectomy, duodenum, endoscopic and percutaneous procedures, endoscopic drainage of a simple pseudocyst, endoscopic insufflation, examining the staple line for hemostasis, failed endoscopic treatment, failed nonsurgical methods of treatment, failed percutaneous treatment, figure of 8 fashion, formal debridement, full resolution of symptoms, gastric access, gastrotomy, greater curvature, increasing pain, individualized, ineffective, infected cavity, infective pancreatic pseudocyst, interrupted absorbable braided sutures, intracorporeal closure, irrigated, laparoscopic transgastric ultrasound, lysis of adhesions, maturation of cyst, mature persistent pseudocysts, minimally invasive, mixed solid fluid and gas collection, near full resolution, necrotizing pancreatic abscess, NG tube, no evidence of recurrence, open surgery, pancreatic fistula, paragastric vasculature, percutaneous drain, percutaneous drainage, peritoneal cavity, peritoneoscopy, persistent fluid collection, persistent symptomatic pseudocyst, persistent symptoms, placement of transgastric ports, port placement, posterior gastrotomy, posterior wall, posterior wall of the stomach, prevention of inadvertent injury, puncture, puncturing into the fluid collection, purulent fluid, pylorus, re-examined, readmitted, reinflated, scheduled follow up, severe case of gallstone pancreatitis, significant necrotic component, simple pancreatic pseudocysts, simple retrogastric fluid collection, small cavity, solid components, solid necrotic components, solid necrotic parapancreatic tissue, stapled with a 6 cm device, stent migration, stomach access, subxiphoid position, surgical drainage, transgastric stents, transgatric approach, ultasonography, ultrasonic dissector, umbilicus, uneventful recovery, upper abdomen, very low rate of recurrence, visualized