Laparoscopic Cystogastrostomy for Pancreatic Pseudocyst: A Case Report

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Abstract

A 49-year-old man with a history of acute pancreatitis was hospitalized with a diagnosis of pancreatic pseudocyst. Ultrasonography, computed tomography, and magnetic resonance imaging all demonstrated a homogeneous cyst, 9 × 4 cm in size, at the tail of the pancreas without mural nodules or septa. Because an intestinal structure was identified between the cyst and stomach preoperatively by computed tomography and endoscopic ultrasonography, laparoscopic cystogastrostomy was carried out instead of percutaneous or endoscopic cyst drainage. The cyst was exposed by dissecting the lesser omentum and found to have no adhesion to the surrounding tissues. Anastomosis was performed using an endoscopic linear stapler via small cystotomy and gastrotomy openings on the lesser curvature, which were then sutured laparoscopically. The postoperative course was uneventful. Laparoscopic surgery is recommended as a safe, reliable, and minimally invasive treatment for managing pancreatic pseudocyst.

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Endoscopic management of pancreatic pseudocysts.

J. Terblanche, Jake Krige, P Bornman … (1997)

Pancreatic pseudocysts may produce pain, or biliary or duodenal obstruction. Those over 6 cm in diameter or associated with chronic pancreatitis are unlikely to resolve and usually require intervention. There are a number of treatment modalities available and this paper reviews the role of endoscopic drainage. All articles and case reports quoted on Medline (National Library of Medicine, Washington DC, USA) containing the text words 'endoscopy' and 'pseudocyst', and citations from these references were reviewed. Endoscopic drainage is technically feasible in around 50 per cent of pancreatic pseudocysts associated with chronic pancreatitis. Successful drainage occurred in 82-89 percent. The major complication is bleeding which required surgery for control in 5 per cent of procedures. One death attributable to the procedure has been reported. Recurrence rates range from 6 to 18 per cent with up to 4 years' follow-up. As in open surgery, recurrence is highest with drainage via the stomach. Endoscopic drainage provides a minimally invasive approach to pseudocyst management, with success and recurrence rates similar to those of open surgery but with lower morbidity and mortality rates. It should be considered the treatment of choice for pseudocysts less than 1 cm thick which bulge into the stomach or duodenum, or for those which communicate with the main pancreatic duct.

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Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage.

Paul Fockens, Tanya Johnson, Hendrik van Dullemen … (1997)

Endoscopic drainage of pancreatic pseudocysts has become an established alternative to surgery. We performed endosonography before endoscopic drainage to find out whether detailed anatomic information would help in the selection of appropriate candidates and result in a reduction of complications. Between April 1992 and July 1995 endosonography was performed in 32 patients, referred for endoscopic pseudocyst drainage, to determine the minimal distance between the pseudocyst and the gut, to identify interposed vascular structures, and to determine the optimal site for drainage. Endosonography failed to identify a pseudocyst in 3 patients and in 2 patients the lesion was inconsistent with a pseudocyst. In 7 patients transmural drainage was considered inappropriate: in 4 the distance between the gut and the cyst was too large, in 2 varices were present between the cyst and the gut, and in 1 patient normal pancreatic parenchyma was present between the cyst and the gut. In 20 patients endosonography was followed by ERCP, and in 19 endoscopic drainage was attempted. Transmural drainage was successful in 16 patients. Endosonography changed management in 37.5% of the patients. Endosonography provides essential information prior to endoscopic drainage of pseudocysts, leading to a change in therapy in one third of patients.

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Laparoscopic pancreatic surgery.

M. Anvari, V Tandan, Seongmin Park … (1999)

Potential applications for laparoscopic surgery in pancreatic disease include (1) staging of pancreatic malignancies; (2) palliation of pancreatic malignancies; (3) pancreatic resections for benign and malignant disease; and (4) pancreatic drainage procedures. A review of the literature is presented. In addition, original data on a series of 5 laparoscopic pancreatic distal resections and 10 laparoscopic cystogastrostomies are presented. Laparoscopy may have a role in the staging of patients with pancreatic malignancies; however, with high-quality preoperative imaging, the percentage of patients who will benefit from laparoscopy may be as low as 5%. For palliation, both cholecystoenterostomy and choledochoenterostomy can be performed laparoscopically. The former is technically straightforward but has a higher failure rate; the latter is technically difficult and currently not suitable for widespread adoption. Laparoscopic gastroenterostomy is a straightforward means of palliating gastrointestinal obstruction. Patients appear to benefit from laparoscopic distal pancreatic resection but not from laparoscopic pancreaticoduodenectomy. Patients appear to benefit from laparoscopic pseudocyst decompression.

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Author and article information

Contributors

Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Faculty of Medicine, Fukuoka, Japan.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Oct-Dec 2000

Volume: 4

Issue: 4

Pages: 309-312

Affiliations

Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Faculty of Medicine, Fukuoka, Japan.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Author notes

Address reprint request to: Shuji Shimizu, MD, Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Faculty of Medicine, Fukuoka 812-8582, Japan. Telephone: +81-92-642-5442, Fax: +81-92-642-5458, E-mail: shimizu@ 123456surg1.med.kyushu-u.ac.jp

Article

PMC ID: 3113193

PubMed ID: 11051191

SO-VID: 6b55f07c-5fb2-4a81-8941-339b7be1859c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Laparoscopic Cystogastrostomy for Pancreatic Pseudocyst: A Case Report

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Abstract

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ScienceOpen Clinical Case Reports Collection

Most cited references 5

Endoscopic management of pancreatic pseudocysts.

Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage.

Laparoscopic pancreatic surgery.

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