Laparoscopic Management Of Pancreatic Pseudocysts A Novel Technique Using Titanium Clips Our Experience

Pseudocysts of pancreas is collection of fluid in the lesser sac enclosed by a wall of fibrous or granulation tissue as a consequence of acute pancreatitis, pancreatic trauma or chronic pancreatitis. Invasive drainage procedures are currently indicated in those patients with symptoms or complications. We present our experience of 26 cases of pseudocyst of pancreas managed laparoscopically between Nov-2014 to March-2016 using different techniques of anastomosis using Vicryl 2-0 continues sutures as well as using Titanium clips for creating stoma between anterior wall of pancreatic pseudocyst and posterior wall of stomach. Laparoscopic cysto-gastrostomy appears to be safe and effective approach for internal drainage of pancreatic pseudocyst. It also facilitates the debridement of the necrotic tissue from the cyst cavity. Use of Titanium clips can be an alternative to conventional sutured cystogastrostomy and stapled cystogastrostomy, as it is less time consuming, easy to perform and cost effective

Laparoscopic Cystogastrostomy for the Patient of Pancreatic Pseudocyst with Intra-abdominal Adhesion

A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.

Laparoscopic Cystogastrostomy in Pancreatic Pseudocysts: A case report

Laparoscopic surgery on the pancreas is carefully attempted because the pancreas is a retroperitoneal organ and because the tissue is very fragile and composed of abundant small vessels. Recently, the authors experienced one case of a laparoscopic cystogastrostomy for a pancreatic pseudocyst. The patient was a 43-year-old man and a chronic alcoholic. He visited the emergency room for severe abdominal pain which had lasted for 2 weeks. Ultrasonography revealed a huge pseudocyst in the retroperitoneum. The size of the pseudocyst was 10 cm 9 cm, and it was located at the pancreatic tail in the abdominal CT. Through four 10 mm ports, the gastric anterior wall was longitudinally incised about 4 cm; then, a communicating window between the stomach and the pseudocyst was made with endoscopic cautery after using needle aspiration to recognize the cyst. The pseudocyst was completely gone in the follow up CT, and the man was discharged without complication on the postoperative 10 th day. The laparo scopic cystogastrostomy is not only a feasible operation but also a minimally invasive and effective method for treating huge, maturated pancreatic pseudocysts.