Pancreatic Cystogastrostomy by Combined Upper Endoscopy and Percutaneous Transgastric Instrumentation*

Abstract

Minimally invasive endoscopic and radiologic techniques have been reported for internal gastric drainage of pancreatic pseudocysts but these have significant technical limitations. A purely endoscopic approach to cystogastrostomy provides limited access for instrumentation and hemostasis. Radiologically-guided percutaneous techniques cannot regularly provide an adequately wide cystogastrostomy opening. Reported is a patient who had a pancreatic cystogastrostomy performed using a minimally invasive surgical approach combining upper endoscopy and percutaneous transgastric surgical instrumentation. The upper endoscope essentially served as a camera. A percutaneous endoscopic gastrostomy tube served as a port for inserting laparoscopic instruments into the stomach. The laparoscopic instruments were used to create a 1.5 cm cystogastrostomy opening similar in size to what could be created by an open abdominal approach. The laparoscopy instruments provided good tactile feedback and excellent hemostatic control. Avoiding an open abdominal procedure shortened postoperative recovery and reduced patient discomfort. Although the pseudocyst recurred once, the same procedure was performed again and there has not been a recurrence for 10 months. The authors conclude that this minimally invasive surgical procedure provides an excellent alternative approach for internal drainage of selected pancreatic pseudocysts.

Acute and Chronic Pancreatitis — Complications

“…The main predictors for failure of this method are sudden ductal obstruction (cutoff), communication between the cyst and the pancreatic duct and an association with chronic pancreatitis. [11,12] 6.9. Endoscopic drainage ERCP is better than magnetic resonance cholangiopancreatography (MRCP) for characterizing the pancreatic duct.…”

Quando e como tratar as complicações na necrose pancreática infectada

“…Percutaneous drainage of the pseudocyst and endoscopic internal drainage with placement of a pigtail, or even with endoscopic cistogastroanastomosis already been performed, but showed high recurrence rates due to small holes that were created, plus the occurrence of complications such as bleeding or drilling 3,8,20,55,58 .…”

Minimal-access approaches to complications of acute pancreatitis and benign neoplasms of the pancreas

“…The anterior gastrotomy is then closed using a stapling device [36]. Laparoscopic intraluminal cystgastrostomy involves four trocars, two of which are introduced into the gastric lumen using simultaneous laparoscopic and gastroscopic guidance with gas insufflation via the gastroscope [32,33,38,39]. Cautery and sharp dissection are used to create the cystgastrostomy.…”