title: Long-term outcome of laparoscopic cystogastrostomy performed using a posterior approach with a stapling device.
abstract: BACKGROUND
  Internal drainage of an acute pancreatic pseudocyst is indicated 6 weeks after its first detection. Laparoscopic treatment of pancreatic pseudocysts enables definitive drainage with faster recovery. Pseudocysts located adjacent to the posterior gastric wall are best drained by pseudocyst gastrostomy. Although the anterior approach for drainage has frequently been reported, reports on the posterior approach are rare.
  
  
  METHODS
  Seven patients underwent laparoscopic cystogastrostomy for pancreatic pseudocysts. The posterior approach that enables the direct visualization of the posterior gastric wall and pseudocyst was used, and the cyst was drained with a needle. After creating a sufficient drainage orifice, the cyst was thoroughly debrided. Cystogastrostomy was performed using the posterior approach with a stapling device. The insertion site of the stapling device closed using a hernia stapler.
  
  
  RESULTS
  Cystogastrostomy was performed using the posterior approach with a stapling device in all patients, without requiring conversion to the anterior approach or open surgery. There were neither operative complications nor late recurrences during the follow-up period (median 65 months).
  
  
  CONCLUSIONS
  Laparoscopic cystogastrostomy using the posterior approach, which facilitates adequate internal drainage, is a safe and feasible procedure for pancreatic pseudocyst, and it is not accompanied with a risk of recurrence in the long term.
authors.affiliation: Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan. ooida.takatsugu@yokochu.jp
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Oida
authors.forename: Kenji
authors.initials: K
authors.lastname: Mimatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Hisao
authors.initials: H
authors.lastname: Kano
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kuboi
authors.forename: Osamu
authors.initials: O
authors.lastname: Aramaki
authors.forename: Sadao
authors.initials: S
authors.lastname: Amano
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000601:surgery*; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome