Minilaparoscopic transgastric cystgastrostomy

Abstract

Background A technique combining upper endoscopy with percutaneous transgastric minilaparoscopic instrumentation for the formation of pancreatic cystgastrostomy is safe and effective for the internal drainage of pancreatic pseudocysts. Methods At a tertiary-care academic medical center, 6 patients with pancreatic pseudocysts with a mean size of 19 cm (range, 16–23 cm) were selected for combined endoscopic and percutaneous transgastric minilaparoscopic (1.7–2 mm) pancreatic cystgastrostomy. All pseudocysts had been followed-up for a minimum of 5 weeks (range, 5–22 wk) and were noted to significantly displace the stomach anteriorly. Results The mean surgical time was 98 minutes (range, 45–150 min). The mean amount of fluid removed from the pseudocysts was 2167 mL (range, 1600–2600 mL). All ports were removed from the stomach without the need to suture the gastric wall or skin except for 2 gastric serosal sites that were closed with a single intracorporeal stitch. The length of hospital stay averaged 2.2 days (range, 0–6 d). All patients were discharged in good condition, tolerating a regular diet. With a mean follow-up period of 13.4 months (range, 1–30 mo), all patients remain asymptomatic from their pancreatic pseudocysts. Conclusions The technique of combining upper endoscopy with percutaneous transgastric minilaparoscopic instruments to create a pancreatic cystgastrostomy can be used to apply well-established surgical principals for internal drainage and has the potential to be used for the management of other gastric pathology.