Laparoscopic Cystogastrostomy

Cystogastrostomy is a surgery to create an opening between a pancreatic pseudocyst and the stomach when the cyst is in a suitable position to be drained into the stomach. This conserves pancreatic juices that would otherwise be lost. This surgery is performed by a pancreatic surgeon to avoid a life-threatening rupture of the pancreatic pseudocyst.

Laparoscopic cystogastrostomy is an invasive surgery used to drain pseudocysts and can be performed by a single surgeon because of the advanced tools. The pseudocyst is identified and accessed using laparoscopic techniques. Once the pseudocyst cavity is located, it is entered and aspirated, and an opening is created into the stomach for drainage. Laparoscopic drainage may result in better cosmetic appearance and decreased pain following surgery.

With advancements in minimally invasive techniques, laparoscopic cystogastrostomy has become a viable alternative to open internal drainage of Pancreatic pseudocysts.

Pancreatic pseudocysts: Pancreatic pseudocysts (PPs) are collections of pancreatic secretions that are lined by fibrous tissues and may contain necrotic debris or blood. The interventions including percutaneous, endoscopic or surgical approaches are based on the size, location, symptoms and complications of a pseudocyst. With the availability of advanced imaging systems and cameras, better hemostatic equipments and excellent laparoscopic techniques, most pseudocysts can be found and managed by laparoscopy.

Procedure

Laparoscopic cystogastrostomy would be done under general anesthesia. A port would be placed subumbilically for laparoscopy, two 5-mm working ports will be placed in the left subcostal area and a 5-mm port in the subxiphoid. An ultrasonically activated scalpel would be used to create an anterior gastrostomy at the maximal displacement site of the stomach. A laparoscopic needle will be introduced to confirm the location of the pseudocyst and to sample fluid. Then, the scalpel would be used to create a cystogastrostomy opening approximately 4 cm in size between the adherent posterior and anterior gastric walls of the pseudocyst. Later, electrocautery diathermy and titanium clips can be used to achieve hemostasis at the bleeding sites in the cystogastrostomy. The anterior gastrostomy will be closed using a linear stapler.

Outcome

Laparoscopic drainage of mature PPs is minimally invasive and offers definitive drainage. Over the past years, laparoscopic surgery of the pancreas has increasingly emerged as a procedure in the treatment of PPs. Laparoscopic procedures for pancreatic pseudocysts include pancreatic cystogastrostomy, cystoduodenostomy, and cystojejunostomy.

Laparoscopic cystogastrostomy is a safe, feasible and effective procedure for pancreatic pseudocyst with minimal morbidity.