Endoscopy-assisted, single trans-gastric trocar, laparoscopic pseudocysto-gastrostomy A minimally invasive alternative for drainage of large pseudocysts
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Abstract
INTRODUCTION: Pancreatic pseudocyst is a complication of acute and chronic pancreatitis, which requires treatment in correlation with its size, symptomatology and mass effect on adjacent structures. Currently, pseudocyst drainage can be done within the stomach or small intestine through endoscopic, laparoscopic or open surgery approach.
AIMS: In this paper we present a hybrid surgical technique applied by our team on 3 consecutive patients with pancreatic pseudocyst.
METHOD: The pseudocysts were in all cases internally drained by endoscopic assisted laparoscopic approach, this article highlighting the technical aspects of this procedures. The patients were known with repeated episodes of acute pancreatitis. Imaging examinations indicated the presence of large pancreatic pseudocysts in all cases, for which we decided to perform a mechanical pseudo-cysto-gastro-anastomosis done laparoscopically-trans-gastric through a single trocar under endoscopic guidance.
RESULTS: The length of surgery was from 60 to 90 min with no intraoperative blood loss recorded. The laparoscopic ultrasound was used in all cases to facilitate the safe localization of the future anastomotic site. The laparoscopic examination of the pseudocyst cavity was done systematically and in 2 cases revealed necrotic areas requiring debridement. The patients had no postoperative complications and were discharged 4-6 days after surgery.
CONCLUSIONS: Internal drainage of pancreatic pseudocyst inside the stomach, by the technique described above, is facile, giving the patient the advantages of endoscopy and minimally invasive surgery. In these circumstances, we consider it superior to endoscopic drainage, by providing a broad communication between the pseudocyst and stomach cavity, reducing the risk of relapse and abscess formation. Moreover, it offers the possibility of exploring the pseudocyst cavity and of removing any necrotic tissues. The endoscopic assistance makes possible the single trans-gastric trocar approach, limiting the injury of the gastric wall.