title: Pancreatic pseudocystgastrostomy with a peroral, flexible stapler: human natural orifice transluminal endoscopic surgery anastomoses in 2 patients (with videos).
abstract: BACKGROUND
  Complex, symptomatic pancreatic pseudocysts often must be surgically drained. Natural orifice surgery is an emerging field in which surgical procedures are performed by using an endoluminal approach through an existing body orifice.
  
  
  METHODS
  Two patients at our institution, an academic, tertiary care center.
  
  
  METHODS
  Two patients who underwent a standard, stapled, surgical cystgastrostomy for drainage of a complex, infected pseudocyst by using a flexible stapling device are described. These procedures were performed under endoscopic observation and guidance, all transorally, without the need for laparotomy or laparoscopy.
  
  
  RESULTS
  Both patients had a technically successful outcome, and both did well after surgery, with only mild chest pain and throat discomfort in one, and no adverse sequelae at all in the other patient. Both patients had complete resolution of their complex, debris-filled pseudocysts at 6 weeks when examined by endoscopy and at 3 months when examined by CT.
  
  
  CONCLUSIONS
  An entirely endoscopic, peroral, stapled pseudocystgastrostomy is feasible and can lead to an excellent outcome. For properly selected patients, this may be an alternative to more traditional types of surgical cystgastrostomy.
authors.affiliation: Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Romanelli
authors.forename: David J
authors.initials: DJ
authors.lastname: Desilets
authors.forename: David B
authors.initials: DB
authors.lastname: Earle
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D004322:Drainage / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D013528:Surgical Staplers