Laparoscopic endogastric and transgastric cystgastrostomy and pancreatic necrosectomy.
OBJECTIVE
Pancreatic pseudocysts (PP) that complicate acute necrotizing pancreatitis (ANP) and require internal drainage may be managed laparoscopically. We present our experience with the laparoscopic endogastric and transgastric approaches to pseudocyst-gastrostomy (PCG).


METHODS
Seven patients (4 female) aged 25-75 (median, 60) years with large (median, 12cm), symptomatic and persistent (median, 5 months) retrogastric PP underwent PCG. All procedures were attempted laparoscopically. The endogastric approach was applied in the initial three patients and was replaced with the transgastric approach in the subsequent four patients. All patients underwent concomitant necrosectomy for sterile pancreatic necrosis. Patients were followed up with regular abdominal ultrasonography. Results shown represent median (range).


RESULTS
There were no conversions to open surgery. The operating time was 135 (60-200) minutes and was longer with the endogastric approach (165 vs. 112 minutes). There were no postoperative complications and the postoperative hospital stay was 2 (1-4) days. There were no recurrences at a follow-up of 12 (2-21) months.


CONCLUSIONS
Laparoscopic PCG with concomitant necrosectomy for PP that complicate ANP is feasible and safe and is associated with smooth and rapid recovery. The transgastric approach provides better access and is simpler to apply than that of the endogastric approach.
Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.
Anas M
AM
Owera
Basil J
BJ
Ammori
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000601:surgery*