Laparoscopic transgastric endolumenal cystogastrostomy
and pancreatic debridement.
A 25-year-old man was diagnosed with a pancreatic pseudocyst following alcohol-induced acute pancreatitis and underwent a cystogastrostomy
. However, cyst drainage was not adequate, and cystogastrostomy
was revised to a Roux-en-Y cystojejunostomy.
The necessity for a mature wall around a pseudocyst or walled-off pancreatic necrosis is imperative, as endoscopic cystogastrostomy
can lead to free perforation in its absence.
A detailed written and informed consent was obtained from the parents, following which the child underwent exploratory laparotomy and transgastric cystogastrostomy
; amylase level in the cystic aspirate was also elevated (1487 IU/L).
For those with ductal communication with strictures, we advocate internal drainage in the form of cystogastrostomy
or cystojejunostomybased on the anatomic proximity of the pseudocyst to the stomach wall.
Advances in endoscopic techniques and ultrasound guidance have made endoscopic cystogastrostomy
and pancreatic necrosectomy the preferred options for treatment of infected pancreatic pseudocyst or walled-off pancreatic necrosis.
Laparoscopic Pancreatic Pseudocyst (PP) surgery can be performed via anterior or posterior cystogastrostomy
, endoscopy-assisted surgery and cystojejunostomy.
Moreover, as result of the thin cyst wall, internal drainage such as cystogastrostomy
or Roux-Y cystojejunumstomy was inappropriate which might give rise to a large number of complications such as anastomotic fistula, infection and cyst recurrence.
Two of the patients in this series were originally misdiagnosed elsewhere as having pseudocysts and underwent cystogastrostomy
. Biopsy of the cyst wall demonstrated the unusual and distinctive papillary architecture of the tumour and provided the correct diagnosis and referral to our hospital.
This can either be done endoscopically using a flexible endoscope to establish a fistula between cyst and stomach or with laparotomy, gastroscope and cystogastrostomy
. The benefits of minimally invasive surgery over laparotomy prompted the use of this modality to establish cyst-gastrostomy.
The endoscopic alternative to the transpapillary approach is transmural drainage, via cystogastrostomy
% Small bowel resection 8 26.67 8 26.67 and anastomosis Appendectomy 7 23.33 3 10.00 Splenectomy 3 10.00 5 16.67 Right hemicolectomy 4 13.33 2 6.67 Gastrojejunostomy 0 0.00 3 10.00 Ileostomy 3 10.00 0 0.00 Pancreaticojejunostomy 2 6.67 1 3.33 Feeding jejunostomy 0 0.00 2 6.67 Fundoplication 0 0.00 2 6.67 Diversion colostomy 1 3.33 1 3.33 Abdominoperineal 0 0.00 2 6.67 resection Cystogastrostomy
2 6.67 1 3.33 Total 30 100.00 30 100.00 Table 2.