Long-Term Outcome of Laparoscopic Cystogastrostomy Performed Using a Posterior Approach with a Stapling Device

Abstract

Background: Internal drainage of an acute pancreatic pseudocyst is indicated 6 weeks after its first detection. Laparoscopic treatment of pancreatic pseudocysts enables definitive drainage with faster recovery. Pseudocysts located adjacent to the posterior gastric wall are best drained by pseudocyst gastrostomy. Although the anterior approach for drainage has frequently been reported, reports on the posterior approach are rare. Methods: Seven patients underwent laparoscopic cystogastrostomy for pancreatic pseudocysts. The posterior approach that enables the direct visualization of the posterior gastric wall and pseudocyst was used, and the cyst was drained with a needle. After creating a sufficient drainage orifice, the cyst was thoroughly debrided. Cystogastrostomy was performed using the posterior approach with a stapling device. The insertion site of the stapling device closed using a hernia stapler. Results: Cystogastrostomy was performed using the posterior approach with a stapling device in all patients, without requiring conversion to the anterior approach or open surgery. There were neither operative complications nor late recurrences during the follow-up period (median 65 months). Conclusion: Laparoscopic cystogastrostomy using the posterior approach, which facilitates adequate internal drainage, is a safe and feasible procedure for pancreatic pseudocyst, and it is not accompanied with a risk of recurrence in the long term.

Laparoscopic versus open cystgastrostomy for pancreatic pseudocysts: a case‐matched comparative study

“…The reported morbidity, mortality and recurrence rates of these procedures are 10–30%, 1–5%, and 5–20% respectively . However, minimally invasive endoscopic and laparoscopic approaches to internal drainage of PPs have been increasingly reported with comparable postoperative results and some advantages associated with the minimal surgical approach. The laparoscopic methods of drainage can be achieved by cystgastrostomy, cystjejunostomy, or cystduodenostomy and through transgastric, endogastric, exogastric or lesser sac, and infracolic access .…”

Laparoscopic Drainage of a Large Pancreatic Pseudocyst

“…7 Endoscopic management in children is regarded as the gold standard by some 7 ; however, it is reported to have a very high recurrence rate. 5 In our case, endoscopic drainage was not possible due to the huge size of the cyst. External drainage alone can have very high recurrence and complication rates.…”

“…4 Laparoscopic internal drainage can be performed using anterior and posterior approaches. 5 The anterior technique is easy to master, while the posterior laparoscopic approach requires more sophisticated laparoscopic skill. 6 Most laparoscopy case series, however, report cyst sizes below 12 cm.…”

Urgent laparoscopic gastrocystostomy after iatrogenic perforation of pancreatic cyst - case report and literature review.

“…Although there are several guidelines to minimally invasive management of pancreatic pseudocysts, only a few papers compare laparoscopic techniques. Those that do favor the posterior approach for its precision, better cyst visualization, easier tissue sample collection and wider anastomosis between the lesion and stomach [ 10 , 11 ]. In case of urgent surgery provoked by complications during endoscopy Elmunzer et al .…”