Objective: This presentation demonstrates intragastric balloon retention facilitating a transgastric laparoscopic cysto-gastrostomy for pancreatic pseudocyst.
Methods: Via endoscopic and laparoscopic methods, 3 balloon-tipped operating trocars were inserted into the stomach. Transgastric identification of a pancreatic pseudocyst was accomplished with drainage of the pseudocyst via a permanent cysto-gastrostomy, created laparoscopically. Pseudocyst drainage was confirmed endoscopically and laparoscopically, as were the operating gastrostomies after laparoscopic closure.
Results: The patient was discharged home on day 4 after this 3-hour procedure. This is the second of 2 such procedures performed at this institution. The first lasted 3.5 hours, and the patient was discharged on postoperative day 2. Each has been followed for a year postoperatively with an uneventful recovery and full resolution of their pancreatic pseudocysts.
Conclusion: Acute fluid collections occur in 30% to 50% of severe pancreatitis cases. After 4 weeks to 6 weeks, these fluid collections may coalesce into a formal pseudocyst that typically is extrapancreatic and in the lesser sac. Complications of pancreatic pseudocyst include infection evolving into a pancreatic abscess, rupture leading to pancreatic ascites, erosion into the thorax creating a pancreaticopleural fistula, or production of a mass effect with gastric or duodenal obstruction and pain. Various methods of pseudocyst treatment have been described including endoscopic, percutaneous, laparoscopic, open, or combinations of the above. We demonstrate with video and still images a combined technique using an endoscope and the transgastric laparoscope with balloon-retained trocars inside the stomach to improve visualization and facilitate the minimally invasive approach to the pancreatic pseudocyst.
Society of Laparoendoscopic Surgeons
Authors: Todd A. Nickloes, DO, Matt Jones, MD, Craig S. Swafford, MD