title: Laparoscopic transgastric endolumenal cystogastrostomy and pancreatic debridement.
abstract: BACKGROUND
  Cystogastrostomy is commonly performed for internal drainage of pancreatic pseudocysts (PP) and concomitant debridement of walled-off pancreatic necrosis (WOPN). While an open approach to cystogastrostomy is well established, an optimal minimally invasive technique continues to evolve. This laparoscopic transgastric endolumenal cystogastrostomy presented here allows for a large cystogastrostomy with complete debridement of necrosis and internal drainage through a minimally invasive approach.
  
  
  METHODS
  We performed a retrospective review of 22 patients with symptomatic PP/WOPN treated with attempted laparoscopic transgastric endolumenal cystogastrostomy (Lap-TEC) and pancreatic debridement. Short- and long-term outcomes were assessed.
  
  
  RESULTS
  From November 2006 to March 2013, a total of 22 Lap-TEC/pancreatic debridement procedures were attempted; 15 were completed laparoscopically. The median age of the cohort was 49.5 ± 12 years (range = 18-71), average body mass index = 29.1 kg/m(2), 77 % had an ASA score ≥ 3, and 10 were female. Gallstones were the most common etiology (50 %), and median time between initial presentation and surgery was 86 days (range = 0-360). Median operative time and estimated blood loss were 213 min and 100 cc, respectively. Forty-one percent of the patients were admitted to the ICU postoperatively and the average length of stay was 14 days (range = 4-50). Median follow-up was 2 months (range = 0-62.5), with one patient having a procedure-related complication. No other reoperations, late complications, or mortalities occurred. All patients had resolution of their symptoms and fluid collections.
  
  
  CONCLUSIONS
  This technique of internal drainage via Lap-TEC and pancreatic debridement has been successful in achieving primary drainage and relieving symptoms of PP/WOPN with no mortality and minimal morbidity.
authors.affiliation: Section of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Simo
authors.forename: David J
authors.initials: DJ
authors.lastname: Niemeyer
authors.forename: Ryan Z
authors.initials: RZ
authors.lastname: Swan
authors.forename: David
authors.initials: D
authors.lastname: Sindram
authors.forename: John B
authors.initials: JB
authors.lastname: Martinie
authors.forename: David A
authors.initials: DA
authors.lastname: Iannitti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D013997:Time Factors; D055815:Young Adult