title: Laparoscopic pancreatic cystgastrostomy.
abstract: OBJECTIVE
  Internal drainage of acute pancreatic pseudocysts is indicated after the first 6 weeks of pseudocyst documentation. It is also indicated for symptomatic chronic pseudocysts 6 cm or more in diameter. When a pseudocyst is in close contact with the posterior wall of the stomach, it is best drained by pseudocyst gastrostomy.
  
  
  METHODS
  Intragastric surgical techniques were used in 18 patients with retrogastric pseudocysts. Intragastric ports were successfully placed in all patients, and the presence of pseudocysts was confirmed by needle aspiration in 17.
  
  
  RESULTS
  The intragastric approach was successful in 14 patients. In three cases a small abdominal would 8 cm in length was needed. The reasons for such conversion included uncontrollable bleeding from the cystic wall in two cases and a cystic wall in contact with, but not adherent to, the posterior gastric wall in one. Bleeding was controlled through a gastrotomy, and cystgastrostomy was performed. The wound required for conversion was much smaller than that needed for planned open surgery. These procedures are called laparoscopy-assisted cystgastrostomy. Good short- and long-term results were obtained. One patient, in whom the cystgastrostomy was too small, developed a cyst infection and underwent reoperation. Except for this case, no recurrence was observed, and no further treatment was needed.
  
  
  CONCLUSIONS
  This experience demonstrates that cystgastrostomy with the intragastric surgical technique is a safe, less invasive procedure for effectively draining a retrogastric pseudocyst.
authors.affiliation: Department of Surgery I, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mori
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Atomi
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D016896:Treatment Outcome